15 hours with a chicken on your lap, and how to schedule an operating room

Why is it so hard to get to see a surgeon and get your surgery scheduled?  If you haven’t thought about it much, you probably figure: first come, first served.  (This and other obscure English expressions explained below.)  If you have, in fact, thought about it a bit, you probably figure: emergencies first, and then elective surgeries.  Makes sense–it’s “truthy,” as Stephen Colbert would say.

It turns out that it’s more complicated than either of these.  Setting up the operating room schedule is one of the most difficult tasks for the organizers of the Surgicorps mission that brings me to Guatemala this week.  Here are some of the things that you have to balance:

1. Any non-insane surgeon with an operating staff that’s new to each other will start off with some easy cases.  It gives everyone a chance to get to know each others’ rhythms and quirks in a relatively low-pressure environment.  So, after we screen a couple hundred patients on Sunday and sit down to schedule a bit over 90 of them for surgery in the week to come, some of the easy ones get put down for Monday.
2. One of our major, major goals is to not have anyone left in the hospital when we leave, which is the Saturday after we arrive.  This means that difficult cases that will require longer recovery times need to be done early in the week to maximize the chances of getting them discharged before we leave.
3. A corollary of requirement (2) is that you want to do relatively easy stuff that’s not likely to require overnight hospitalization on Friday.  So, Friday is the time for complicated dressing changes and the like.

So: requirements (1) and (3) compete for the easy patients.  Requirements (1) and (2) compete for Mondays.  There are a couple other things that come into play, though.

15 hours with a chicken on your lap

There are lots of volunteer groups that come to Central America to provide free surgical services to people who can’t begin to afford them.  What makes Surgicorps different is the mix of specialties that we bring.  Lots of groups have a specialty of one sort or another, and people throughout the Guatemalan health care system know what they are, where those groups will be, and when they’ll be there.  If you need hand surgery, then since that’s one of our specialties–and a hard-to-find one–then if you’re lucky, you’ll be advised to show up in Antigua Guatemala–same place, same week, every year.

Consequently, people show up for screening day from all over the country.  If you have the average income–which is to say, not very much money at all–then your options for long-distance transportation boil down to just one: a camioneta.  This is a bus.  But, not just any bus.  It’s basically an old school bus, typically painted in some colorful and multihued way.  These things get packed full of all the people–and stuff–that they can carry, and you may do your travelling in the company of various and sundry species of livestock.  If you’re from the farther reaches of Guatemala, it’s maybe a 15-hour camioneta ride to the town in the highlands where we do our thing.  15 hours, quite likely with your kid, who is about as likely to be able to sit still for that long as any other toddler on the planet.  15 hours with three people jammed onto a school bus bench meant for two children.  15 hours with, quite possibly, somebody’s chicken on your lap.

So, if you’re the person trying to put together the schedule for the week’s surgeries: now you’ve got an issue.  Let’s say that you have someone with an easy surgery to do.  You want to save a bunch of those for Friday, so if you have people who are local, you send them home, and have them come back Friday morning.  But, you can’t do that with someone who travelled for hours to get there.  So, you might need to move them earlier in the week.  Let’s call this requirement (4).

Then you’ve got the fact that most of the people who show up on screening day fall into one of two groups: (1) kids, and (2) people who do manual labor to support themselves and their families.  If the patient is in the “kids” group, then they were brought by at least one of their parents.  If the patient is in the “manual labor” group, then they’re not working, which means that they’re not supporting themselves and their families.  So, this plays into the equation, too: these folks might have typical surgeries, in which case you want them in the middle of the week, or easy surgeries, in which case you probably want them at the end—unless they get picked for Monday, when you will recall that you want the easy surgeries to get your team used to working together–but, economics dictates that it’s best if you can do them early.  (The same applies to the parents of the kids, who are not working as long as they’re sitting in Antigua waiting for their child to be operated on, but at this point, I can’t wrap my head around how to explain just how complicated that one can get.  It’s been a long day–see here for what a description of what a Sunday is like on one of this trips.)  We’re going to call this requirement (5).

So, let’s review the conflicting constraints:

• (1) and (2) compete for Mondays.
• (1) and (3) compete for the easy patients.
• (1) and (4) compete for the beginning of the week.
• (1) and (5) compete for the beginning of the week.

How do you work all of this out?  I don’t know–yet another reason that I’m just an interpreter.  There are people in the artificial intelligence field who have been trying to figure this kind of thing out for years—the military is happy to pay for the research, because you have to figure out a similar kind of problem if you have a bunch of different kinds of troops, supplies, and equipment that you need to get to an area of armed conflict, and only a limited number of ships and planes to move them in.  I don’t know of anyone who is jumping up and down to do this for a little volunteer group, though.  And, I’ll tell you the truth: I seriously doubt that anyone could do this better than our people do.  There are an enormous amount of variables that go into this–I’ve only sketched out the ones that are so obvious that even an interpreter would notice them.  (For context: I was a medic in the military for some years, so my “obvious” might be different from your “obvious.”)

So: what happens to the people who don’t get to go early in the week, and who live too far to go home and come back later in the week?  It depends.  A routine sight on our way to the hospital in the morning: a family waking up after spending the night in the open bed of a pickup truck.  They’re not our patients, though.  We provide housing for families while they’re waiting for their kids to get operated on, and while the kids are recovering before their discharge from the hospital.  Who pays for that: generous donations from people like you.  Us volunteers pay for our plane tickets, lodging, and other needs, as well as kicking in a week of vacation time.  Surgicorps pays for the patients’ costs, and Surgicorps’s money comes entirely from donations.  You could make one of those donations right now!  $250 will pay for transportation, food, and lodging for a patient and their family during the hospital stay.  $250 can also cover all surgical costs for one patient.  $100: four surgical packs.  $25: one surgical pack.  $10: all of the ibuprofen that we will hand out all week long–and, yes, our patients go home with nothing but ibuprofen.  Are you feeling like life is shitty today?  Give some money to help someone who needs it–you’ll feel better instantly.

English notes below.  Spoiler alert: we’ll talk about first come, first served; truthiness; and to be put down.

• First come, first served: This is a saying that expresses the cultural belief that all other things being equal, services are rendered or goods are given in the order in which they are requested.  How it was used in the blog: If you haven’t thought about it much, you probably figure: first come, first served.
• Truthiness: This is a recently invented word that unfortunately has quickly become indispensable.  Wikipedia’s definition:  Truthiness is a quality characterizing a “truth” that a person making an argument or assertion claims to know intuitively “from the gut” or because it “feels right” without regard to evidence, logic, intellectual examination, or facts.^[1]It was invented by the comedian Stephen Colbert in reference to assertions made by President George Bush with respect to a Supreme Court nomination and the invented excuses for invading Iraq, among other things.  How it was used in the post: Makes sense–it’s “truthy,” as Stephen Colbert would say.  It turns out that it’s more complicated…
• To be put down: This is an idiomatic expression with multiple possible meanings.  Here are the ones that I can think of:
  • From Google: to lower someone’s self-esteem by criticizing them in front of others.
    An example of this usage from Twitter: Why does my dad always find a way to put me down.  
  • There’s a related form of this idiom that adds the preposition for plus something else.  In that case, the “something else” is the excuse for the criticism.  An example of this from Twitter: My nephew dressed up in girls clothes and my family are just putting him down for it, it makes me so mad.  Another Twitter example:  people calling him ugly he’s been through so much but he can still find happiness stop putting him down for something unimportant.
  • Also from Google: to lay a baby down to sleep.  An example from Twitter: still awake 24 hours later.. someone send Ana to put me down.  Another Twitter example, with an optional for: Holding my brother and putting him down for a nap makes me fall asleep too. Gets me every time.  Another Twitter example, with another optional for + something else, this time with a totally different meaning of the “for:”  Not that putting him down for 20 minutes is a bad thing”
  • We saw some examples of idioms with put someone down for something, where the “for” and the following phrase were optional.  There’s another form of this idiom that has to appear with the preposition for, and then something else.  The definition of one of them, from Wiktionary: to record that someone has offered to help, or contribute something.  In this case, the “something else” is what the person has offered to provide as help or as a contribution.  Put me down for twenty bucks. 
  • …and, finally: the sense with which the idiom was used in the post!  This meaning also has to appear with for plus something else, but in this case, the “something else” is something that you’re associated with in some unspecified way.  From a tweet by Jon Favreau: Go ahead and put me down for no, Trump will never drop out.  Meaning: associate my name with the set of people that ascribe to the idea that “no, Trump will never drop out.”  Another Twitter example: Being opposed to strawberry doesn’t mean I want vanilla. Put me down for chocolate, or mint chip, or blackberry, or praline, or sherbet…  Meaning: the person would like to have chocolate, or mint chip, or…see whatever.  Here’s the example from the post: So, after we screen a couple hundred patients on Sunday and sit down to schedule a bit over 90 of them for surgery in the week to come, some of the easy ones get put down for Monday.  Meaning: some of the easy patients are put on the list of people who will be operated on on Monday. 

Back to French and Spanish when I’m a little less frazzled–screening day is a handful!