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Diary: A U.S. surgeon in Nepal :: By Dr. Phillip T. Guillen

DHULIKHEL, Nepal: I’ll never forget the day the earth moved under my feet while I tried to perform surgery to fix a broken arm.

About two weeks ago, a special orthopaedic surgical team from the Loma Linda Medical Center in California arrived in Nepal to help the many victims of the massive, deadly earthquake.

I was on that team and our orthopaedic surgical cases — involving the fixing of almost every broken bone imaginable — began winding down by the evening of May l0th. We were discussing flying back home to our families in the Los Angeles area.

On the rooming of May 11, though, one of our surgeons, Dr. Scott C. Nelson, was contacted by a surgical Nepalese colleague at Dhulikhel Hospital, located about 20 miles east of Kathmandu. He was hoping Dr. Nelson could help with spinal surgeries for the day. I accompanied him and we ended up operating in two separate operating rooms.

I was placing my last cortical screw into the ulna bone of Ram Chandra Regmi, a 47-year-old Nepali man, when there was a rumble and the building began to shake. We had experienced several aftershocks during our time in Nepal, but they had lasted only two to three seconds. I figured the aftershocks would settle down soon and we could return to fixing the patient’s broken arm.

Only after the hospital building began moving like a small boat in menacing ocean waves for more than five seconds that I realized that we were in trouble. Suddenly, the walls began shaking and the cabinet’s contents falling. I looked at the door of the operating theater. My first instinct was to jump out of my operation chair and stand in the doorway, like we were taught in grade school. Then, I realized we couldn’t leave the patient. I looked at the Nepalese surgeon who was operating with me and I looked at the surgical tech and at the patient. I knew we had to stay.

Nepali Dr. Pramod Baral put his hand on the patient and emphasized that we were here for humanitarian work and God was with us. That helped calm me down. Then the building started to shake with more force than I knew was possible. I sat there feeling so helpless with that realization that hits you when you know you have no control of life and death. I was just waiting for the roof or walls to begin collapsing. The shaking would not stop and we all just sat looking at each other, holding the patient.

Then the trembling stopped after 40 seconds or so. I had no idea how long it had been. It seemed like forever. I quickly placed the last screw into the patient’s arm.

I began sewing up the open wound as fast as I could, but I could not stop my hands from shaking. I wanted to flee so badly. I wanted to join everyone running outside to safety. But I needed to finish the operation before we could leave.

Still, I kept thinking: Would another earthquake hit? Would some structural component of the building give way and kill us?

My hands continued to shake, so badly that Dr. Baral asked if he should take over. Having too much pride, I knew I had to finish. Take a deep breath and sew.

When you realize you are not going to escape a precarious situation, your brain makes this conversion from escape/fleeing to knowing that it may be, in fact, time to die and there is nothing you can do about it. Then you wait.

It reminded me of what Crazy Horse would always say before going into battle: Today is a good day to die. In fact, this battle cry seemed to be protective as he never died in the Indian/American battles. Today was not a good day to die. I hadn’t even met my first child. Before leaving Los Angeles, I found out my wife was pregnant.

We felt the ground shake, again, as I was placing one last stitch. But the shaking lasted only 3 to 5 seconds, nothing like the earlier major earthquake. Still, we feared another big earthquake would hit.

The patient told Dr. Baral that he wanted to jump up from the operative table, but he was being held down by the operation team.

We wrapped my patient’s arm as fast as we could with a bandage and I threw off my surgical gown and made my way to Dr. Nelson. I wanted to see if he was OK.

“That was a bit of a shake, huh? Was that the worst one you have been in?” I asked, since he had minimized the smaller aftershocks during the week, saying they didn’t feel anything like the aftershock he felt while in Haiti in 2010.

He told me this was worse.

Dr. Nelson is an amazing surgeon and I have never seen him nervous or scared in any situation. But by the speed he was inserting spine screws and his hands slightly shaking, I knew he had thought of the fragility of life.

He said that the “C arm tech” had run out of the room and the scrub tech was so scared she frantically hit the back table and half of the pedicle screws fell to the floor, screws that cost between $200 to $900 each. Luckily, in Nepal, they pick them up off the floor and take them to the sterilizer and use them again.

I grabbed Dr. Nelson’s phone to call the team commander, Andrew Haglund. He had already texted us: “Are you guys OK?” I texted him back that we were OK, but that we had both been placing screws in the bones when the massive earthquake hit.

Dr. Nelson had been putting his second spine screw in at the Ll pedicle bone with exposed spinal cord when the earthquake began. He had this screw pointing at his patient’s spine when the shaking was so violent he couldn’t safely place it. Dr. Nelson kept holding his hand on the screw in the spine pedicle, and then decided to keep screwing it in. His staff just prayed, saying if it was our time to go…we were going to go.

Then the Internet went down and even with an international signal I could not get through to the commander.

I took the phone outside and was taken aback by all the nurses wheeling inpatients outside. People setting up UN tents and blankets over patient beds so the sun would not dehydrate and burn patients. The ED (Emergency Department) had set up a front yard ED with IV poles. Linen-covered mattresses were placed on the cement in front of the hospital. Patients with external fixators on, dressings with drains, active burn patients, all were being wheeled out of the hospital.

I doubted I would ever be in a moment like this again. Who lives through something like this in a lifetime? This was a true emergency disaster in a third-world country and it was happening at lighting speed.

I dialed my wife in the United States. I wanted to tell her I loved her because I knew I had to go back to the operating room where Nelson was. I couldn’t just leave him in the building and stay outside. I wanted to tell my wife I loved her so much, because once I went in I didn’t know if l would come back out if there was another earthquake.

The call failed over and over again even though the signal said it was great. I tried my mom and dad several times and it failed each time. I guess I needed some comfort from loved ones but soon realized I was not going to get it now.

I went back inside the hospital and then we felt the earth shake, again. The building began rocking again. I grabbed a British surgeon and urged him to get under the doorway with me. He looked at me as if l was crazy and told me to just run outside with him.

This aftershock was not half as strong as the first and lasted only 10 seconds, at the most. When it subsided, I ran back to Dr. Nelson’s operating table.

The surgical scrub nurse — a very petite 4-feet-10-inches Nepali young lady — had this look of desperation and sadness. I could tell she wanted to get out of there. I asked Dr. Nelson if there was anything I could do, should I scrub in? How can I get you out faster? He had a Nepali orthopedic resident with him and told me there was nothing I could do at this point.

I looked at Roshni, the scrub nurse, and told her I would scrub her out if she wanted to go. I would take her place. What she said next will stay with me for the rest of my life.

“I can’t leave my surgeon,” she whispered.

:: Dr. Phillip T. Guillen documents the experience of treating Nepali earthquake victims on May 12, when a 7.3 magnitude aftershock killed an additional 83 people in three countries. The original magnitude-7.8 earthquake, which occurred April 25, killed more than 8,000 people. Photo: Courtesy Phillip T. Guillen

For Indian tourists travelling by land:- 72 hours (-ve) C-19 report, CCMC form and Antigen Test at entry point

For Indian tourists travelling by land:- 72 hours (-ve) C-19 report, CCMC form and Antigen Test at entry point

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