Kitty Holbrooke: Medicine, Final Week

And like that, it’s over. Five incredible weeks in the tropics and I am back in the mountains, glad to be home, but missing the island.

The crew at the last OR procedure

Monday morning we were up bright and early, heading to the hospital for the last time. Lexi and I led the now-instinctive way past maintenance, radiology, pathology, the welcome desk, up the stairs, through the OR doors, and into the OR lounge where we were met by the familiar faces of the PA’s at the round table. Our only case was a breast reduction that was smaller than our previous patients, so we planned to be done in the early afternoon. However, the nurses had serious trouble finding a vein to insert the IV, and once ready we were still at the will of the island and were delayed two hours.

Once in the OR, Dr. Moorman had all six students switch out scrubbing in, giving us all one last opportunity to play surgeon. As I dried my hands of the iodine bactericidal solution and donned my sterile gown I was sad at the thought that it may have been the last time I ever have a place at the operating table. All the PA students stressed how lucky we were to, one, have such a great preceptor, and two, to have the opportunity to be in an OR, let alone scrub in and actually participate at our age.

We sewed our final sutures, cut our finishing stitches, rolled our last patient into the recovery room, and went home. That night we were met with a completely unexpected tropical storm that covered the horizon with cracks of lightning. Unlike most storms, this one came unannounced with no warning whatsoever, meaning the hurricane shutters had not been put up, nor any other preparations made. The sheer volume of rain building up on the deck and the angle at which it hit the glass walls of the living room led to insane flooding. We soaked up what we could with mops and towels, switching off who dried and who wrung them out in the shower; it was a full family affair.

As the second band of the storm came to a close and the rain lightened for a few minutes, Lexi and I sprinted down to our apartment to unplug the devices at risk of a power surge and grab whatever dry towels we had left, while Dr. Moorman and Andreas put up as many storm shutters as they could. The power never ended up going out and no damage was done to the property but it sure was an exciting night.

Tuesday was a routine follow-up, consultation, office day, not particularly different than any of the previous. Many skin checks, a few breast reduction consults, and all our follow-ups from last week’s operation filled our busy day of 42 patients. The only unique case was a man with a mass on his buttocks which, when his wife had squeezed it to emit pus, had ejected a plastic capsule, most likely an undissolved hormone injection. We examined the hard lump, neither cystic nor lipoma-like, and scheduled an excision in the near future. After the long day we went to taco tuesday at Maria’s cantina with the PA’s while Dr. Moorman, despite our protestations, stayed at the office to finish paperwork.

Wednesday morning we slept in and headed to the office for our last procedure day. With 19 appointments from 10 a.m. to 5 p.m. it was a fairly slow day, but a great one. We started off by removing the staples from the Dermatofibrosarcoma Protuberans excision from the Monday before. The patient was young and outgoing and didn’t protest when Dr. Moorman had Alexis and I put on a pair of gloves and remove the staples from her scalp with a staple remover not totally unlike those you could find at Office Depot.

The remainder of the cases were more or less mundane, with the regular skin lesion removals and keloid injections, but we did have one emergent case with a man who had stepped on a sea urchin. The encounter had occurred a few days prior but his large toe had continued to swell up and was clearly infected. With no sort of anesthetic, Dr. Moorman took a needle and, for lack of a better word, stabbed the callused part of the sole of the toe, resulting in an ejaculation of pus. To avoid any more nasty details, he “cleaned up” the toe as best as he could much to the pain of the patient, and prescribed him with a heavy duty antibiotic to battle the infection.

Removing Kahley’s skin tag

After a cancellation in the late afternoon, we found ourselves with a large window of time before our next case, a vial of Lidocaine, and two PA students willing to experiment. Lexi and I both drew up one cc (cubic centimeter) of Lidocaine with Epinephrine, our first time handling the syringes and needles. Kahley had been wanting to remove a skin tag on her chest for years and under the supervision of Dr. Moorman, Lexi injected the lesion with the Lido and Elise snipped it off. The “procedure” was all superficial, so sterility and sutures were not necessary. Megan, the most curious of the PA students, did not have anything to be removed, but had always wanted to feel the effects of Lidocaine in order to authentically empathize with her patients. Under her detailed direction, I wiped away the bacteria with an alcohol pad, held my hand as steady as possible, and injected the entire cc into her forearm. Although she felt the “stick and a burn” most patients complain about, she tolerated it very well and created an incredible learning experience for me.

Soon after their “grueling procedures,” the PA’s were dismissed to “recover” and we were left to help Dr. Moorman gather data on his ten last consecutive breast reductions. Every year he has to send in ten consistent, consecutive cases to renew his plastic surgeon’s license, so we helped him by printing out all the op-notes and recording statistical data such as patient age and weight of tissue removed from each breast. We went home exhausted but prepared for the hours of card games with the kids to come.

Last beach day

Thursday we awoke ready for another office procedure day only to find a text telling us to sleep in and take the day off. We spent the morning at home packing up, playing cards, waiting for the painters to finish up, and then headed to the beach. We went to the Buccaneer which seemed fitting as it was the first beach we had gone to during our first weekend on the island, and now it was our last. We swam in the ocean, played both volleyball and tetherball, and were picked up in the evening after only two awkward encounters where other patrons of the beach took Ava’s boogie board thinking it was resort property. From the beach we headed to Kmart to buy some last minute souvenirs for our biological families, and headed home to finalize our packing.

Friday was slightly melancholy as we loaded in the suburban and drove down the bumpy, pot-hole laden road to the Gallows Bay office for the last time. It was a cosmetic day, the second since our arrival, so we dressed up and retired our scrubs for the time being. The first few patients were follow-ups or post-ops, including the woman who’s osteomyelitis we had removed from her thumb the week before. She was sad to hear it was our last day and gave each of us a kiss on the cheek and a hug as she left the office. The majority of the patients were here for Botox or Juvederm injections, the process of which I explained in my first blog. The patients were solely women, ranging in age from 35 to 75. I was shocked by how fine the majority of the lines they came to get rid of were, and now have a new understanding of the extent to which self-consciousness goes, especially in aging women.

Cosmetic day

Dr. Moorman was always very careful not to inject too much, always offering free touch-ups as a preferred alternative to bloated, fake-looking faces. A few of the patients were private and refused to let student observers, but we still each got to see quite a few injections and watch his steady, meticulous technique. After a sweltering lunch on the Christiansted boardwalk with the PA’s, we finished out the day and said our sad goodbyes to the office, Sheila the secretary, and Megan, Tyler, Kahley, and Elise.

Lexi and I saw our final breast reduction follow ups, finished up what paperwork and SOAP notes we could, and made the somber drive home to our last night with the family. We had a nice dinner, played (to no one’s surprise) some cards, zipped our suitcases and went to bed.

Saturday morning we were up by 5:45 a.m., out the door by 6:15 a.m., and at the airport by 6:30 a.m. (perks of a small island with no traffic). The youngest and oldest of the kids were still asleep but Stefán and Gabriella were awake to see us out and Lexi couldn’t help but shed some tears as we hugged them goodbye. They truly have been the best host family I could ever wish for and did an outstanding job making us feel like one of their own. Dr. Moorman insisted on dropping us off at the airport and waiting till we were checked in despite the fact he and his family were flying to Iceland an hour after we departed.

The flight to Miami was easy and we were met on the other side by Megan, the PA student, who was flying home to Utah. She entertained us throughout the four-hour layover by leading us in yoga and stretches on the floor of an empty gate we stumbled upon in Terminal E. We parted with Megan once again and boarded our flight to Phoenix where we had yet another long layover before our final flight to Grand Junction. Significantly easier than our way out, we successfully landed in Junction early, having had no delays or mishaps throughout the long day of travel, and were reunited with our families.

Being home now is bittersweet as I am glad to be back with my dogs and bed, but I miss the wonderful times, friends, and family we made there. I would like to thank Sarah Holbrooke (hi Mom) and the entire Pinhead staff and donors for giving us this opportunity as well as everyone at the Gov. Juan F. Luis Hospital and the Moorman Aesthetic Center for letting us be part of the team for a month.

Lastly I would like to extend my endless gratitude to the entire Moorman family for their generosity, kindness, tutelage, and stellar cooking skills.