We are down one of our crew today as Lucy from Chain of Hope had an early flight back to London this morning. It was so wonderful to get to spend some time with her and learn more about the wonderful work Chain of Hope does in the world! Thank you Lucy for your coordination and contribution that has forever changed the lives of these children!
After a quick breakfast, we found Dr. Kal already waiting for us outside the hotel. It is Jordan’s Independence Day today, as they celebrate 70 years of independence. The usual crazy busy traffic of the streets is not to be found as Jordanians celebrate their holiday. We arrived to the hospital so quickly!
We checked in to the OR and found they were not ready with blood for the patient (for perfusion), so there was a slight delay. Then off to the ICU we go to check on the children…
Salma was still having some heart rate issues despite medications to slow it. She will get some medication to calm her to see if this will help. Her father said she has not been sleeping much at all and seems to get anxious with all the constant stimulation (and especially our large team all staring at her for rounds!). We will try some “calming medications” to see if this is pain/stress causing done of her heart rate issues. She is just beautiful!Rital is doing great! She will transfer out to the floor later today. She is Postop Day #2 as well of her peri membranous VSD repair. Her parents are still smiling ear to ear when we see them!
These two girls share a room, then the other three occupying the ICU are together in a larger room at the end of the hall… Little 4 month old Anas (POD #3 (lg VSD, PDA) is doing well, he may go out to the floor later today. He has a little cough when he eats mom says. He is still so alert and so sweet!
Khalid is the 9 mos old POD #1 Tet repair. He is doing well. No concerns. He was sleepy , but so adorable as he kept kicking his leg up that had the sat monitor on his toe…like he was doing some heel stretches or something! He will of course stay in the ICU today.
Noor was hurting of course this morning. Not happy… Medically doing great in her postop day #1 VSD repair.
Then we floated down to the floor… Roulan will go home today after her interventional cath yesterday. She is doing great and room air sats were 84% today. That is a noticable improvement for her!
Raghad looks like a new girl! Ear to ear smiles! She will go home today as well POD#3 lg VSD/ASD repair. Raghad is one of the younger of her mother’s 9 children. She will go home to Jerash, Palestine today. The first patient of the day was Owais. He is a 3 yr old boy from Palestine who presented to Dr. Kal with shortness of breath with exertion and not growing well… He has an ASD. Dr. Sammy the anesthesiologist who has worked so hard with us all week wanted us to clear him before going to sleep as he has a rash on his face… We checked out this sweet little guy who has a non-itchy rash of mostly his face in the last couple days. No fevers, feeling fine. Not on the chest. Seems non-bacterial, so we proceeded with surgery. His surgery went very well patching the ASD with a Dacron patch and he was sent to the ICU.
The second case of the day was one we saw in Dr. Kal’s clinic yesterday. Abd Alrahaman is a beautiful Iraqi boy with thick hair and a sweet face. He is 13 months old and has been operated once for his VSD with a pulmonary artery band as he was a “blue baby” or cyanotic since birth… He also had a cleft palate with a failed repair the first time and bilateral inguinal hernias that have been repaired. In other words, the poor little guy has had a lot of surgeries in his short life… He seemed to have more than the typical amount of bleeding from the start of the case, unfortunately… More adhesions (scarring) to take down given his previous banding surgery. So, in all, this became a longer case than expected as he just kept bleeding. Extra blood products were given (which can take a long time depending on the blood products needed. Platelets tonight took a while). Lots of trying and waiting for the bleeding to slow, and finally seemed to be improving a little and platelets infusion (which should help the most to stop the bleeding!) owas starting, so we closed. Dr. T knew we would be watching him closely tonight…
Then, we had added Ala’a as a third case. She is the Syrian girl with a small VSD and cath and echo numbers that just “don’t add up”… She is a very sick little 2 year old with very low SATs, low heart rate, shortness of breath, etc. she is very sick. Dr. T and the team did her Tetralogy of Fallot repair in September. She was initially doing well and then was suddenly dick and getting sicker… This tiny VSD that is now there is a mystery. Definitely not there after surgery in September, a cath by a different cardiologist recently and a ballooning of the pulm valve has now not seemed to help her current situation either. She was the topic of the long case co defense yesterday. It was then after 7:00, I believe, when we were taking her back to the OR… We planned to do a TEE (echo) when she was asleep and possibly a pacemaker. The question is, does she need the small VSD repaired and will that fix her problem? The TEE still shows a small 3.5-4.5 mm VSD … Some clips of this were recorded to share with the Riley case conferences at home to help decide what may be the best next steps for this sick little girl… She needs medically “tuned up” it was decided, before doing anything more (pacemaker, VSD repair, etc…)
We then counted instruments and packed out OR supply trunks from home for departure tomorrow. We checked on the children in the ICU. Have to share this gorgeous smile from sweet Noor with her beautiful quilt given to all the kids from GOLA!
We then departed straight from the hospital to the Gift of Life Amman (GOLA) dinner at Na’el and Ruba’s house. We were already late to the party, but what a lovely celebration outside in their courtyard of a full week, a new, vibrant GOLA board, our Chain of Hope partners, Rotarians in fellowship, and Na’el’s birthday! Such incredibly warm and hospitable hosts our Jordanian friends are!!
While we were at dinner, Dr. Kal called to talk to Dr. T. Unfortunately, little Abd had taken a turn for the worst after being extibated. His SATs and heart rate suddenly dropped and he had to be put back on the venitalor. He was still having troubles, so after several calls to and from Dr. Kal, it was decided we must go back to the hospital. DG Mustafa drove us to the hospital in all the crazy Independence Day celebratory traffic! It was an interesting sight! But traffic was crazy!! We finally arrived to the hospital before Dr. Kal had arrived. Dr. T instantaneously started troubleshooting the possible problems. When Dr. Kal arrive do, echo was fine and showed the repair and heart overall looked great! He seems to be in fulminant pulmonary edema, with bloody frothy sputum from his ET tube… Meds started and actions taken and his SATs and BP were coming up, so Dr. Kal encouraged us to get back to the hotel to start to pack for our fairly early departure. He said he would manage the rest of the night by phone for this little guy. He is so dedicated and a wonderful doctor and friend!! We pray that little Abd Alrahman will pull out of this rough patch! It is still going to be a rough night of not yet knowing for this sweet little man.
We depart the hotel early tomorrow morning. We cannot thank enough our GOLA hosts, Chain of Hope for sponsoring these children’s care, Gift of Life D6560 Indiana for sending the team and of course Riley for allowing Mike and Dr. Turrentine to get away to treat these children who needed them so much this week! Thank you to the hard-working and talented Al Khalidi staff and the incredible Dr. Kal! We have completed 10 open heart surgeries, 2 Caths and one procedure (TEE) in 5 operating days! It was such a productive and memorable week! We thank everyone for their wonderful support of this amazingly fulfilling work! “Mending little hearts,” as Chain of Hope says, is quite an awesome accomplishment, but it truly takes amazing teamwork of so many- in the “theatre” (OR) and soooooo many more “behind the scenes”!
Tuesday starts with another efficient and on- time departure for Al Khalidi. Dr. Kal tells us that Salma is still having some SVT overnight and that Anas had some issues as well. Thankfully, an observant ICU nurse picked on some subtle signs that showed Anas was getting into some CHF and this was then picked up on chest X-ray and quickly treated. Anas looked great when we saw him this morning in the ICU! Doing much better… He will be weaned off his oxygen and possibly moved to the floor.
Raghad is the 12 year old PAPVR, SVSD, PFO repair from Sunday. She needs to cough…. They put her back on oxygen overnight, but she just seems to need to cough and do her IS and get up a bit. She is doing very well.
Salma will get some more medications for her rhythm issues and some blood transfusions for extra fluid and will remain in the ICU.
Rital is looking well also. She will start to eat today.The two children on the floor are looking great! Islam Aska was all smiles until the doctors pulled out their stethoscopes to touch her! I’m sorry I missed a picture of her sweet smile when we first walked in! She will likely go home today!
Ayesheh is doing very well also and should go home today as well…Our first operation of the day is Khalid. He is a 9 month old boy from Aqaba (Jordan) who has Tetralogy of Fallot. He is not growing well and not strong enough to develop normal 9 month old milestones like pulling up to stand… We learn as he is prepped for the case that the assistant surgeon will not be able to make it due to an injury for any of this mission… Thankfully the skilled and incredibly helpful Hannan would get me through another few cases! Khalid’s case goes very well (TOF repair with Goretex ventriculoplasty, PMVSD, pulm valvotomy) and he is sent up to the ICU where Dr. Turrentine talked with the male members of his family.
We quickly went to Dr. Kal’s office to discuss which patient will be operated tomorrow afternoon. There are many patients needing surgery, but some can await a next mission and others may be too complex to do on the last day of the mission. Dr. Turrentine does not like to leave the country when patients may be too sick or complex in their recovery. So, it was decided that Dr. Kal would bring in a couple children for more evaluation/echo with Dr. T this afternoon. Although it seemed rather quick, we were called that the OR had been waiting on is for the next patient, so we hurried down to get started on the next case…
Noor is a lovely 6 year old girl from Jordan with an ASD. Her surgery went well and quite quickly! Her surgery was complete before 3:30! Pictures of her promised tomorrow!
Dr. Kal was calling for us to come to the cath lab as soon as possible when we scrubbed out. He had Roulan in the cath lab trying to find the source of her cyanosis as she has been previously banded for her complex heart disease. (Previous Italian- performed Glenn, then a completion Fontan done by Dr. Turrentine, covered by Gift of Life/the Ferland family from Indianapolis in approximately 2009). She was found to have several collaterals and a large venous to venous shunt that are likely the causes. Chain of Hope agreed to cover the cost for the family of this Syrian girl’s Venous Occluder and coils that should shut those down and she will feel so much better! Her pre-cath sat was 76% and her post- cath sat on room air is now 86-90%! She said she already feels so much better!We then met for quite a long meeting to discuss possible cases for tomorrow. It was truly an all-out case conference with Dr. Kal, Chain of Hope friends, our Riley team, Nadeem fro Save the Children and another cardiologist from the University. He has been caring for A’ala, a young 2 year old girl operated by Dr. T in the September mission. She has since had an interventional cath ballooning one of her valves which helped initially. However, she is very sick right now with terrible shortness of breath and low heart rate and ascites. Something has to be done for her, but the controversy is “WHAT?” She has a tiny (3mm) remaining VSD, but it seems unlikely this is causing all of her problems. Her heart rate is quite low for her young age. We will put her on the schedule tomorrow for TEE under anesthesia in the OR and pacemaker placement. She may need a VSD closure as well, but will see.
We then evaluated 2 more children called in for possible surgery tomorrow, one is a VSD with a band and another quite sick, tiny 5 month old with very complex cardiac issues (Downs syndrome with VSD, BVH, pericardial effusion, SATs 76%, tachypneic, Ill-appearing). Dr. T cannot stand the thought of sending them both home with no surgery, but the complex VSD little guy needs some more work-up it seems… We now have 3 cases scheduled for the last day of operating!
We ended our day with a lovely dinner at an Arabic restaurant with many from the new GOLA board. As usual in Amman, the amazing food just kept on coming! Dessert was marked by a captive delivery of this flashy cake to wish GOLA board president Na’el a Happy birthday! Thank you GOLA and thank you Chain of Hope and D6560 Gift of Life for making these families’ dreams of healing their children a reality! So much to celebrate!
It’s a much cooler day in Amman, pretty windy as well, as we left the hotel this morning for Al Khalidi Hospital. We had a lovely breakfast with our British friends who arrived from London last night. Dr. Gavin Wright, Chairman of the Board of Directors of Chain of Hope and Lucy, Director of Overseas Operations have joined us for the rest of the week’s stay. As mentioned before, COH is covering the hospital costs for the patients and their families. This is their second mission involvement here in Amman. We are so thankful for their partnership! The new members of Gift of Life Amman are incredibly involved and excited about this mission as well. District Governor Mustafa Nasereddin and RI Vice President 2016-2017 Jennifer Jones visited us in the OR today as well. GOLA also had arranged for some television coverage of this mission and the children also. We were surprised to look up from the operation at one point to see a large camera quite close! We are so happy for GOLA to bring such wonderful attention the families of the Middle East who need their help for their congenital heart defects!
We first visited the ICU where our 4 patients from the previous 2 days are doing well. Ayesheh is recovering… She has a little bit of a junky cough and EKG was done worried about some elevated heart rate at times, but it seems to be sinus tachycardia which is reassuring. Will just continue to watch this. She will likely get rid of her chest tube today later as well and moved to the floor! Islam Aska is recovering well also… She had a great night, is even trying out a smile or two and moved later in the day to the floor!
Raghad is doing better today in her postop day 1 Repair of PAPVR and SVASD… No reported troubles for her. She will continue to recover in the ICU today.
Anas is doing pretty well for postop day 1 VSD and small PDA repair. Still getting some oxygen via mask. Mother looks more at ease with it all today, thankfully.
Our first patient of the day was Salma, an almost 9 mos old Jordanian girl with a complex cardiac defect considered a transitional complete AV canal with pulmonary stenosis and ASD as well. While her case is complex, the two patch technique closure of the AV canal and direct closure of the ASD, and volvotomy with PA patch is all done before 12:30. She was doing quite well when transferred to the ICU. Her family speaks excellent English and asked very good questions about her repair as Dr. Turrentine spoke with them after the case.
Rital is a beautiful, curly-haired 18 mos old from Syria who was hungry and ready and waiting for her surgery time as we came out of the OR areas after Salma’s operation. She was found to have her murmur at a post natal check as a newborn. She has a large peri membranous VSD and bilateral SVC’s. The OR staff was excellent and efficient as always and Rital does beautifully with a wonderful TEE postop and she was transferred to the floor. We found an ICU nurse who was able to translate for us to tell her young sweet parents that her surgery went very well. Dr. Turrentine always gives the remnant of the Dacron patch to the family to show them the size of the hole that was patched. They were incredibly thankful!
During the last surgery, Dr. Kal also performed a cath with PDA closure on a Syrian patient also sponsored by Chain of Hope. I’m sor I don’t currently have all of her story, but GOLA president Na’el was kind enough to share her photo with me. She recovered and went home!
We made another round through the ICU to check on the patients before heading to Dr. Kal’s office to make plans for tomorrow. Salma is having some SVT (irregular heart rhythm). She was given some extra meds and a little extra attention before we left for the day…
Tonight, we relaxed all together with a dinner of wonderful hummus and falafel and then traditional Kanafe with Dr. Kal and our Chain of Hope friends.
We have two cases planned again tomorrow, thankfully with a true cardiac surgeon to assist Dr. Turrentine starting tomorrow! 👏🏻😊🙏🏻
Sorry I haven’t had more pictures to post. With scrubbing in on the surgeries, I haven’t been free to take as many pictures of the gorgeous kids!
Tomorrow, two more surgeries…
It’s another warm, sunny day in Amman! We departed for Al Khalidi right on time at 8 AM. Islam Aska was crying and unhappy when we entered the girls’ room, but she will get to start to drink and then eat today, so hopefully her mood will improve! Her chest X-ray looks great and she is progressing nicely.
Ayesheh too is hungry apparently… She was trying to chew on one of her telemetry leads! She had a little fever overnight, so antibiotics were changed, but she is overall looking great as well. She will advance her diet also. Our first case of the day is Raghad. She is a nearly 12 year old from a nearby Palestinian refugee camp. She was found to have a murmur on an exam recently and was sent to Dr. Kal for evaluation just one month ago. Amazingly, she was found to have PAPVR, a rather complex combination of heart defects that she has lived with since birth and only now discovered! She will grow and thrive like a normal preteen girl with her heart now repaired! Her case went well despite finding things to be a little more complex than we thought before opening. A Goretex patch was skillfully constructed and placed by Dr. T and we were out of the OR and she was in the ICU before noon.
Dr. Turrentine and Rachel went to Dr. Kal’s office between cases. I’m so sorry to say that I missed Adyan, her twin sister Rnad and their wonderful mother, my friend Noor! Adyan had her final surgeries for her very complex pulmonary artery atresia in Indianapolis at Riley last year. She is apparently doing wonderfully well!
They also did a few more echos and discussed some more patients before heading back to the OR for the next case.
Inas is a small 3 mos old Syrian boy with a large VSD and small PDA. He is having some trouble growing and thriving like all of these children due to his heart abnormality. There were some longer than usual delays due to trouble getting in lines- special IV’s…(the Al Khalidi stag is so efficient, any delay is unusual!). We started the case for Inas about 3 PM. Dr. Kal was unable to get a TEE probe down his little esophagus, so a transthoracic (usual) echo had to suffice preoperatively. A Dacron patch was placed over his peri membranous VSD and his ductus ligated nicely and he was taken off bypass and closed without our usual verification of repair via TEE. He was transferred to the ICU in stable condition still intubated for just a short while.
His mother was in the ICU waiting area when we arrived later to check on him. Dr. T gave her the remnant of the Dacron patch to show her the size of the hole closed between his two lower chambers of the heart… We realized quickly that she does not speak any English and our Arabic is incredibly limited to “Hello, how are you?”, “thank you”, and “you are welcome”- certainly not enough to get us through this comforting, informative discussion that needed to take place! We eventually found someone to interpret and when she later went back to see Inas who was sleeping but breathing on his own, she wept and wept. I have to imagine she was finally letting go of all kinds of emotions she had been feeling all day and likely since his birth! By evening, Raghad was awake and alert and complaining quite visibly that she was hurting. This picture was very soon after her pain medicine helped her to rest well.
Islam Aska resting peacefully!
All the kids were doing well and we left to Dr. Kal’s office to visit another teen to consult on her MItral valve congenital abnormality and make plans from her echo. We then finalized the two patients to be operated tomorrow and headed back for an earlier return to the hotel this evening. After a late night for the gala last night and a full day today, an earlier night is much needed!
I now sit outside on a lovely evening blogging watching a full moon over beautiful Amman! Another early day tomorrow for a full day of operating. Dr. Gavin Wright and Lucy from Chain of Hope join our crew tomorrow!
The Riley/Rotary Team is happy to be back to Amman for Dr. Turrentine’s 18th mission here! The children’s surgeries this week are sponsored by Chain of Hope out of London while the team travel and expenses are covered by Rotary District 6560 Gift of Life. We are multifaceted this week with many different visitors and contributors! Dr. Turrentine is joined this week by Mike Horner, perfusionist, and myself Stephanie Kinnaman, D6560 Gift of Life Advisor and Family Physician (meaning that I am the unqualified surgical assistant this week! 😳). We are also happy to have Rachel from Chain of Hope currently, soon to be joined by her co-worker Lucy and Director of their board of Chain of Hope Dr. Gavin Wright. Also here this weekend for the D2452 Rotary District Conference is Rob Raylman, Executive Director of Gift of Life International. Dr. Khalid Salaymeh- Jordanian Pediatric Cardiologist- is here coordinating and working hard as always! Dr. Turrentine spoke at the District Conference yesterday and they all joined for the evening dinner once Mike and I arrived to Amman.
We started right away today with two surgeries. The Al Khalidi staff was so kind to accommodate a Saturday surgery schedule so that we can hopefully fit in 10 surgeries before we depart later this week. Our first patient of the day was Ayesheh. She is a tiny (only about 16 lbs!) 13 month old from Syria with a VSD and ASD. She was all ready for surgery when we arrived to the OR. Her surgery went very well and she was transferred to the ICU. Her young, nervous family members were all excited to hear that she did well.Next patient was Islam Aska, a 6 year old Syrian with a large ASD. Dr. Turrentine made my assisting even more difficult as usual with his tiny incision to make her scar as small as possible! Lovely for this sweet little girl, but difficult to work in that tiny area! Her surgery went very well also with a beautiful postop TEE and she was transferred to the ICU as well. She also had a large, young family awaiting word that surgery was over… I will get a proper picture of Aska tomorrow!
In the meantime, we met a couple patients in Dr. Kal’s office. A prior patient from 2009 Rulan from Jericho who was operated with a Glenn. She will have a diagnostic cath this week… Also Osama from Yemen who has a previously repaired Mitral Valve at age 2… He is now 11 yrs of age and having worsening Mitral Insufficiency. Osama is a sweet young man who shook hands with each of us and said “Thank you!” He will be considered for mitral valve replacement in the near future.The patients were both off the ventilators and recovering well while we went back to the hotel to ready for the big Rotary D2452 Gala this evening at the Dead Sea! Wow, do the Jordanian Rotarians know how to put on a beautiful party! District Governor Mustafa Nasereddin has been a longtime member and huge support for GOLA and all Gift of Life work. We were happy to join in to celebrate his successes in his year as District Governor! It was a beautiful, warm evening overlooking the Dead Sea.
We have a full day at Al Khalidi tomorrow with two more surgeries planned. Now it’s off to bed for a short night of sleep to ready for another big day tomorrow!
Day 7 – Saturday Goodbyes and Departure
A challenging week is coming to a close. The cases proved to be difficult and complex. And while we would have liked to see more rapid recovery, our patients are indeed recovering. The Ugandan team has enthusiastically stepped up to take full control of each patient’s progress. We packed our trunks, said good-byes, had our annual de-briefing session, and closed with a small farewell party and cake with patients in the regular cardiology ward, families and some former patients. Now for the long journey home.
No individual shout out today. But we all acknowledge the key player and leader of this team, Dr. Mark Turrentine. It is his continuing legacy and vision to provide this cardiac surgery care to places and patients in need, and we belong to the team that he puts together. The reward and benefit definitely goes two ways.
Joey and Melissa had a busy night. Sadat had a drop in blood pressure that required a significant amount of meds to help him recover. By the time we arrived, he was stable and much better. So we took him to the OR to see if we could band his vertical vein and then close his sternum. The suture on the vertical vein to close it had been removed on his first night to help reduce the left atrium pressures. In the end Dr. Mark could only very loosely band this vessel, and then closed the sternum. Sadat tolerated this well and returned to the ICU.
Saidat was intubated yesterday afternoon so that we could more effectively open up her left lung. After this her chest X-ray was much better. So we asked Dr. Joey and Melissa to allow a few more hours of respiratory treatments, and then extubate her (if possible) in the morning before we returned. Unfortunately her pneumothorax (air in the chest cavity) and lung collapse returned very quickly. We decided to call the ENT specialists to see if they could do a test to look for an airway problem, and also to replace her chest tube so we could keep the air out of the chest. This all was done in the OR after Sadat returned. Saidat came back to the ICU intubated but sounding much better. Hopefully she will now make steady forward progress.
Maria was successfully weaned off of her ventilator, and looks very good. Sheila was moved to the step down unit. And Aaron and Thomas continue to progress well.
Despite all of this activity, we did proceed with a last scheduled case – Tracy Kiconco. She is a 6 year old with Down Syndrome and a large VSD. She has some restriction across the VSD, as well as a mild narrowing below her pulmonary valve. She was known to have high blood pressure in her lungs, but a previous cath study showed that she would be safe for surgery. She came from quite far away in SW Uganda, and we really wanted to not have to post-pone her repair. She did very well, and returned to the ICU around 7:30 – 8:00 pm. We are going to follow our typical pulmonary hypertension precautions this first night – which means she will stay on the ventilator.
Our shout out tonight goes out to our daytime Cardiac ICU nurses, Sheila and Rebecca. As always it has been a busy and demanding week that just builds each day. But this year from Wednesday onward has been extra challenging. Often 3 ventilators at a time, alarms, desaturations, low blood pressure, and more. All of this has been handled with grace, excellence, professionalism, and great spirit. And their energy and enthusiasm have continued into our evening dinners and gatherings. They are a true asset to this team.