Sunday, January 7, 2018

Did you know what Encephalocele is?

Victory
If you have ever heard about the amazing work that Mercy ships does you have heard about facial tumors, cleft lips & palates, plastic surgery for burn patients, obstetric fistulas, and eye surgeries to name a few. Mercy ships does a lot of things but did you know we do crainiotomies? No? Me neither until serving on board in 2008. 

These patients are not the ones on the Mercy Ships commercials or websites. So most of the nurses that come are quite surprised to hear that we do crainiofacial surgery.
 
Down on D ward we have an especially intense two week period when we have a team of 3 surgeons Dr. Gary(maxofacial), Dr. Shaleindra(neurosurgery), and Dr. David(plastic surgery).

The first day we did screening. We met each of the patients and looked at the CT scans and the surgeons came up with a game plan. It was really interesting to be involved in the very beginning of the process. I felt like I was in the upper room as I watched these 3 brilliant men come up with a complex surgical plan that would deeply impact these selected patients lives.

At the time they where a name, age, and diagnosis. Now, 6 weeks later, I love these people. They run and give me hugs when I see them at their outpatient appointments and we delight in the their great outcomes.
Julienne

To start from the beginning of the story, I was asked in early September to lead the crainiofacial surgery. I prayed about it and said yes. As I began preparing I taught an in-service to the nurses about the different surgeries we would be doing. The 3 surgeries that we do on the ship that need a crainiotomy are encephaloceles, hypertelorism, and facial clefts.
  • Encephaloceles are a neural tube defect. It occurs in the first few weeks of pregnancy where the skull does not close and some brain tissue is outside of its protective skull. This is seen in the Western world but much less because most pregnant women take prenatal vitamins that contain folic acid. Folic acid has been shown to decrease neural tube defects by 50%.
  • Hypertelorism is when eyes are much more wide apart then usual. This surgery involves breaking the orbits, rotating bone, and using bone putty to fill holes. I find this so cool. It is very much like a puzzle.
  • Facial clefts are basically a hole or gap in bone, soft tissue or both. All three of these require the surgeons to lift the frontal portion of the skull to be able to move around the facial bones. So inevitably the patients will require much more monitoring and most of them spent some time in the ICU.
I round with the doctors each day and continue to until my last patient leaves the ward. Dr. Shailendra and Dr. David left right after surgery was over. I talk/text with Dr. Shailendra frequently with updates, photos, and sometimes videos so he can guide Dr. Gary and I as we have encountered some complications and difficulties.
 
This has been a very sweet and challenging experience. I have done things that I have never done before but more importantly I have seen lives changed. I have seen dramatic changes in appearance, self confidence, and love. I have spent so much time up close (up in their face close) and I have grown to love each one of them fiercely!

I have worked along side some incredible PICU nurses from all over the world. They gave incredible care to our sweet patients that sometimes weren't so sweet. Dr. Gary, Dr. Shailendra and Dr. David have taught me so much. They answered my questions and really listened to me when I had concerns. 

The last day the surgeons were there we took this picture of encephalocele row. Side by side are these precious people that worked so hard for their own or their child's recovery.