My background is in the Emergency Room, so I rarely see the inside of an operating room, as a nurse or a photographer. As a photographer, however, it is far more rare. As previously mentioned, the lack of privacy laws within the hospital allowed me to obtain images rarely seen. In school I was taught that one of the keys of photojournalism is to take readers where they cannot otherwise go. These photos do exactly that. A few of the following images may be a little graphic for those with a weak stomach, so let this be a warning if you are sensitive to those types of images.

Once the room was set up by the nurses, the doctor had spoken with the patient and marked the correct knee, the x-rays had been hung up in the OR and the patient had been brought in and sedated or spinal blocked, then it was time to begin.

The patient was prepped by placing a tourniquet and cleaning his or leg leg and then covering the patient in sterile drapes to prevent infection.

After that, it was time to begin surgery with the first cut.

Once the knee was exposed, flesh was cleared away and Dr. Estrada set to work fitting the implant to the patient’s bones with a series of drills, saws and mallets. Dr. Estrada and the physician’s assistant working with him, Kentucky Skinner, worked seamlessly together. They somehow made this carpentry-like surgery appear artful, though still brutal, with flesh and bone flying through the air.

    It felt bizarre to be a room full of gowned and goggled people, the band Cake or 1990s rap music blaring in the background from an ipod, assisting in drilling bones. It was a glimpse into the everyday life of surgeons, and honestly I can see the attraction to it now. There is a thrill in it and an instant satisfaction.

It is weird to say, but it was kind of fun. Here is an overview of a room during a surgery that I assisted in. I cannot take credit for this photo as I am in it, with my back to the camera, and one of me cleaning off an instrument.

After the bone was cleared away and holes were drilled in preparation, it was measured for the proper implant and then irrigated.

When the implant size was chosen, the nurses mixed cement, which was used to secure the implant to the patient’s bone.

To close, Dr. Estrada put a deep layer of stitches, followed by a more superficial layer placed by Kentucky (which sometimes the nurses got to help with) and then a final layer of staples.

Here Kaitlin and I assist Kentucky. Photo credit to Alexis Brown.

When the surgery was complete and the nurses were left to dress the knee and set up for the next surgery. We had two rooms going at a time, so we could get through more knees. Once the deep stitches were placed by Dr. Estrada, he went over to the next room to begin on the next patient. Here is the same knee from the beginning of my post after the surgery was complete.

At the end of the day, the knees were straighter and much more functional for the patients. It felt really good to definitively accomplish something for someone else. Dr. Estrada said he liked to fix things, and this line of work allows him to do just that. Veliz Aguirre Yeliz Eneida, whose knee is pictured here, came in with a crooked knee and rolled out 45 minutes later with a brand new joint and a chance at getting more out of the rest of her life. It really is pretty amazing.

Neurosurgery was a bit different. It was much more delicate and there were even more instruments involved. Here Dr. Valle and Dr. Thomas work together with surgical technician, Susie, assisting.

Before going on this trip, I had heard stories from my friend about a trip to Nicaragua with this group. During one surgery, Amy was put on fly swatter duty because there were so many flies in the surgical suite. We were not roughing it as much as they did there. There was only one fly incident. Lisa is pointing to it on the ceiling here. It made me think of the Breaking Bad episode about the fly, for anyone who watched that show.

Since the areas neurosurgeons operate on are so delicate and small, things like video and microscopes are key.

My next blog post will be the conclusion of the Ecuador series with a look at some of our patients after their operations and the positive impact it had on their lives and the lives of their families.