Friday, June 29, 2012

Mongolian Queen

I was given this very special gift from the Choibalsan team as I left Mongolia this year. Mongolian women have a respected place in this strong culture and I was incredibly honored to receive this doll. I recommend Jack Weatherford's book "The Secret History of the Mongol Queens" for additional reading on how women helped save Genghis Khan's empire. 

Clapping in the O.R.?

Returning to Choibalsan to work with this team again was truly a joy and a privilege. It was encouraging to see how much the team had learned – in technical skill and in surgical judgment. It was a pleasure to return to a somewhat familiar environment in such a far away land. It was a privilege to work with our friends and colleagues from our last visit.

I took a special pleasure in learning that one silly little thing I had done last time I was in Choibalsan, has become routine here in the operating room. The first time we were teaching here, I used to clap and cheer whenever the gallbladder was finally freed from the gallbladder fossa. I think surgery is fun and I think finding those moments of small victory are worth celebrating. Okay, it’s silly, but somehow, it has stuck. The first day of our trip this year, the operating team cheered raucously after the first gallbladder was released from the gallbladder fossa – and I laughed in shock. They then informed me that they do that for every cholecystectomy … every one.

If the legacy I have left in Choibalsan is the ability to celebrate the small victories – well I am more than fine with that. Cheers to my friends in Mongolia who do their job well and do their job with joy. 

Like a Prayer

The last time we were in Choibalsan, as part of our training program, we introduced the WHO surgical checklist and emphasized the importance of the “surgical timeout.” This short verbalization of the operative game plan introduces the patient, the procedure, and any known issues or potential areas of concern. The “timeout” serves to put the whole operating team on the same page. It is a moment of pause before you carry on with serious business, and sometimes, can be almost, like a prayer.

During this trip, we were happy to learn that the Choibalsan team had adopted the “time out” for all of their procedures. We brought additional translated copies of the WHO surgical checklist for the new operating rooms and started to teach the concept of the “debrief.” I am sure our star students will adopt this practice as well as they have the timeout.

(I encourage anyone who is interested in global health to read Atwul Gawande’s book The Checklist Manifesto)

Wednesday, May 16, 2012

A Most Bromantical Weekend ...

Bros and some heavy machinery

It has taken me a few long drives in the country but I think I finally understand the Mongolian countryside weekend. It’s really not about the destination. And it’s really not a girl thing. It’s a guys road trip. A weekend full of “no romance, BROmance.” Think Winnebago to an away football game in college – now take away the Winnebago, and the freeway, actually, take away paved roads and toilet facilities while you are at it, now you have a Mongolian countryside weekend

It always starts in a pretty benign way – we pile into a Land Cruiser and a Russian van (Note to self: ALWAYS take the Land Cruiser) and we head off into the open spaces that are the Mongolian steppe. We bump along with bright blue skies, gazelles running out of our way, silly looking birds, gorgeous wild horses, a camel or two, some sheep, some yak, some cattle … it’s all good for the first few hours. And then it becomes all boy. Full of beer, vodka, loud singing of ‘Bohemian Rhapsody’ – all while bumping along in a shock-less Russian van that smells like gas fumes. A most Bromantical adventure indeed.

As the only two girls on this weekend of Bromance, JQ and I had some memorable bonding moments. While we stopped often for the boys to pee, the wind was so bad that us girls couldn’t even employ the ‘jacket as butt flap’ trick I had learned the previous year. Thankfully, our kind hosts stopped at some toilet facilities that JQ and I preferred to call “el bano.” We referred to our time standing on wooden boards perched over open pits of raw sewage as “our slumdog millionaire moments” … and note the plural.

I jest a bit – the weekend had some truly incredible moments … we visited an impressive war monument and museum commemorating a WWII victory by the joint Mongolian and Russian troops over the Japanese. Both a ground and air battle were won over this easternmost outpost of Mongolia.

We went fishing in a river that is known for famous taimen (apparently large, rare fish …) and watched the boys get all bromantical over firing an AK-47 at a distant target (none of them hit it fyi … “too windy”). We slept at the local hospital – 9 to a room in hospital beds – the nurses tucked some of us in when we woke up disoriented to the raucous cacophony of snoring in the middle of the night. We visited a hillside Buddha – beautiful in its decay – and powerful in its setting.

Further dusty travel led us into the middle of some Sunday horse racing and gambling, a fish lunch at a local ger, and the most magical of stops for me at the third biggest lake in Mongolia. 90% Mongolian, 10% Chinese this massive body of water looked for all the world like the ocean. It was cold and sandy and there were some of the biggest clam shells I have ever seen washed up on the shore. On the overlooking bluff we found another Buddha.

All along these adventures, the boys back slapped and he-hawed and tried to outdo each other with their silly antics, silly jokes and vodka shots. There were moments of bromantical bonding over mutton, guns, beers, fishing, horses, driving the land cruiser and wading in the water.

The ride home almost killed me. It was a 7 hour rollercoaster ride that took its toll on my kidneys, and my brain.  Breathing gas fumes and holding onto my backseat for dear life I arrived back at the hotel feeling like I had been in a brawl. It was a good weekend, it was a boys weekend, and I was lucky to be a girl along for the most raucous, bromantical ride. 

War Monument

My view from the backseat of the Russian Van

Sunset at our prettiest "bano"

War Museum
Hillside Buddha

Hillside Buddha

Horse Racing

Mongolian Camel

My Mongolian Ocean Moment

Lakeside Buddha

Oyunbold, Mike, Harold ... "Yea BROmance!!!"

Monday, May 14, 2012

Adapt and Overcome

Me and Dr. Mike Marohn before the lap chole became a 7 hour biliary case

Yesterday was a tremendous first day. We spent the first 2 hours in the ICU which had become a makeshift burn unit with the arrival of two serverely burned firefighters from an outlying district. With over 50% total body surface area burns the most frightening part of their condition was their significant facial and neck burns. After assessing their fluid status, Dr. Rust expertly intubated both patients, ensuring both safe airways for the helicopter flight to the burn unit in the capital. With our late start, we moved quickly into our first two lap choles and a lipoma resection. The cases went really well and I was impressed with the improvement in skills I saw in the surgeons we had trained previously.

Then came today….. The local team was itching for us to show them how to do a laparoscopic cholangiogram. I tried unsuccessfully to get Mike (my more senior co-surgeon) to take them through the case but somehow, I was the one scrubbed when we got the image that changed our day. No flow of contrast into the duodenum, and two big filling defects in a dilated common bile duct … for the non-medical folks – when you are in Choibalsan, that means a long day! Adapt we did. The operation was converted to an open common bile duct exploration and trans duodenal sphincteroplasty. Amazing anatomy but 7 hours scrubbed in the OR. Suffice it to say, the team bonded over the trials of that case and when the patient woke up bright eyed and slightly grumpy, we felt a sense of victory.

The next case ended up being an incredibly inflamed gallbladder that Mike and I took over from a frustrated Mongolian team. Their judgement was correct … they should have opened … but Mike and I were able to muscle through the concrete, overcome, and get the gallbladder out intact. We received over enthusiastic accolades for our skills and enjoyed our moment of feeling like the heros.

One final gallbladder left us in the OR until 930pm – too late for dinner, too late for basketball, and just in time for bed.

Mike likes to say he is a fan of “adapt and overcome” … perhaps his first day in Choibalsan was designed as a test of that mantra … adapt and overcome we did. Adapt and overcome …


“Do you want to come to the ICU before or after lectures?” … it is our first day at the hospital and that was the first question we were asked by the head of surgery, Dr. Ganbat. Thankfully, that is an easy one “we’ll go to the ICU”

There was a large fire in the countryside last night. It made the sunset amazing We can still smell the acrid remains in the air in Choibalsan. Three people died and two fire fighters made it to Choibalsan after being in the som (small town) hospital. They each had suffered over 50% burns with significant injury to their faces, hands, and legs. They were not making enough urine, they were not intubated, and they were being transported to the capital. It was a good warm up for us here in Choibalsan. We increased the IV fluid rate and then Dr. Rust skillfully intubated. Once their airways were secure, the patients were transported the burn center in the capital.

I might just be praying before our first lap chole ... 

After that adrenaline rush,  we started cholecystectomies. My first impression was that much had changed at the hospital. The operating suite has been upgraded and there are now three ORs where there had before been barely two. I was impressed by the team and the skills that had improved since our last visit. They communicated well with each other and showed off careful technique. I breathed a sigh of relief as two gallbladders and the resection of two lipomas from an octagenarian went without a hitch. Dr. Marohn arrived at the end of our day and our team was complete.

It is good to be back in Choibalsan. We are happy to see familiar faces in a warm and familiar hospital.  Being delayed in the capital had taken some wind out of our sails but one day in the hospital, doing what we love to do, and we were feeling like our purpose had been re-confirmed. It is good to be back. 

Monday, May 7, 2012

Huh ...

Logistics are often an interesting proposal in Mongolia. Yesterday was technically a logistical nightmare - but i will try to put a positive spin on it and say - it was challenging. In order to catch our 625pm flight to Choibalsan, we left the hotel in UB at 3pm. After 1 hour of driving, we were a 10 minute walk from the hotel ... We eventually made it to the warehouse, grabbed our medical supplies, and headed off. On arriving at the airport we met our translators - check that - our translator. There is "some other guy" with us who is not going to translate and who really couldn't tell me why he was with us at all ... Keep note - we have one translator for our trip to the Mongolian countryside - and my Mongolian is "rusty" (read: non-existent). After haggling with the airlines over our overweight bags - full of medical supplies and food - one of the team members plunked down a private credit card to pay the fees and we were issued boarding passes, indicating we were in the clear ...

Held in the holding area, held after security, put on a bus, taken off a bus, put back on a bus, bussed out to the plane, put on the plane (as they are inflating the tire on the landing gear), taxied to the runway, given the security spiel, sat on the runway with propellers running, and some more of that, and some more, watched a gorgeous sunset from one of those tiny plane windows, and some more sitting, taxied back to the airport, returned to bus, put on shuttle back to the city (sans overweight luggage), left to wait on the street corner for a ride back to the hotel and there, i got to heckle for a rooms for the boys before i crashed with Alli and JQ ... after eating cup o' noodles with my fingers, we pushed beds together and i slept in scrubs on the crack.

So now it is today, and we will try again ... wish us luck!!

Sukhbaatar Square

Saturday, May 5, 2012


It is NOT a well kept secret that I do not like the food in Mongolia. Being a notoriously picky eater who bristles at the sight of gristle and has spent a lifetime carving the fat off my meat, the Mongolian diet of mutton and marmot always presents a challenge. I tend to live on Luna Bars and instant oatmeal and by the end of the trip, crave a salad more than anything on this dear planet. But we all know how food not only sustains us, but is associated with our memories and our emotions. We all know those special smells and tastes that bring us comfort and sate us with a sense of peace. Well mine, here in Mongolia, is the Naan at Hazara North Indian Restaurant in Ulan Bataar. 

We usually get to Hazara the first night we are in country. It is a ritual that grounds us before we head off to the countryside and the work we have planned. It is a laugh filled dinner of Chinggis beers in big german steins and spicy eggplant, butter chicken, lamb kebabs, vegetable pakoras and the best Naan i have EVER tasted. Crispy and chewy and buttery perfection in a big basket of love right in the center of the table. As we devour more than our share, we meet the team, catch up with old friends, and feel "at home" in this far away land. 

My brother, Tucker Yoder, was just named the Best Chef in Charlottesville, Virginia by the Charlottesville-Albermarle Visitors Bureau. There is no doubt he respects the power that food, and sharing a well prepared meal, has to create lasting memories. Food can be that island of the familiar that grounds you in unfamiliar surroundings. Hazara has always been that for me in Mongolia. 

I am back again for another two weeks in Choibalsan. I hope to blog as much as possible but we will see how internet access and time allow. Soon it will be Luna Bars and oatmeal but last night ... it was Naan, perfect, perfect naan. 

Sunday, February 12, 2012


(this entry is from last year ... but seeing as it is almost Valentine's day, the sentiment seemed appropriate <3 Suzy)

Last night we all sat around the café in our hotel sharing a piece of chocolate cake, catching up with Oko (our translator from last years trip). Allison and I started asking her about dating in UB, wondering why this smart, attractive, well-travelled young woman was single. As the conversation expanded, we started hearing the stories of how each of the members of our team had met their wives/husbands and how the rollercoaster of their courtships evolved. Charming stories, familiar patterns, life.

When the talk turned to me I offered the only perspective that I could – I still haven’t found what I am looking for … Smart questions by smart people inspired the honesty of my true heart – what is the deal breaker? Well for me, there is really only one deal breaker …. It is not a physical characteristic, a job title, or a religion; it is not a bank account, a diploma, or a car … the deal breaker for me is passion.

I have met many people through my wanderings and the ones who inspire me, make me feel like a kid, encourage me to be better and learn more – those people have a passion – for something. Be it art, travel, a chosen profession, a volunteer project, an exploration … show me that you care deeply about SOMETHING, ANYTHING.

I am passionate about living, stealing all that I can from this experience and taking all the chances and opportunities that are offered. I am passionate about being a good doctor but an even better friend. I am passionate about trying, everyday, to learn something, try something new. I am passionate about feeling it all, experiencing it all and about finding someone who wants the same ride.

I love my life. There are challenges, and twists and turns, there is a lot of laughter and a healthy dose of tears, but I love it all.

Someday, maybe I will sit in a café in Mongolia, or Africa, or South America, or California and tell a cute story about how I met the love of my life, how we danced around it for awhile and how finally, our passions made us a team. I hope for that, and I keep on loving this life and those who challenge me to live it to its fullest.