#110 Shanksteps
Today started out as most.  Worship at 7:30; nursing sign-out after that.  I then started rounds as usual.  We were down from 65 to 50 patients.   I rounded quickly and was in the office to see outpatients by 10AM.  I saw about 13 in clinic (including one bitten by a rabid dog) then got called by a place we purchase saline in Maroua.  Ours had come in and they had saved it for me, but they would not any longer.  I had to go to Maroua NOW.   So I left for the three hour drive.   The first segment
is along the “staircase” of rocks between here and Mokolo, then on the “paved road” from Mokolo to Maroua.  I often wonder what the (dollar) toll on the road goes toward.  Well, I don’t really have to wonder, I’m sure there is someone making a killing from it.  I got 52 boxes of glucose saline and returned to Koza.  I got a call from Audrey along the way wondering where I was.  She had two patients waiting for me.  It was 7PM:  We unloaded the truck and put all the items in the stock.  Then on to
the patients.
His abdomen was very distended; eyes were sunken in; he appeared like a starvation victim.  Fluid was dripping into his veins, slowly replenishing days, or weeks of slow dehydration.  I had operated on him two years ago for a mass in his upper abdomen.  He was young, 25ish.  And had a scar from top to bottom along his abdomen and another in his right lower quadrant.  He hadn’t made stool for a day nor gas.  He as very tender all over his abdomen and I felt a fluid wave.  I called Allison and we went
to the operating room.  Opening along the midline we entered the abdomen and found a HUUUGE stomach.  It filled his entire abdomen.  The area where I had attached his intestine to his stomach before had scarred with a band across the area kinking off the outlet of the stomach.  While releasing this band I got into the bowel.  A nasogastric tube was placed removing 5 liters of fluid.  I needed to revise this anastomosis. Opening the stomach, it was filled with remnants of food days old.  After re-evaluating
the area we revised the anastomosis between small intestine and stomach and re-sutured the opening.  We closed the fascia and skin.
Next was a woman who had swallowed a fish bone.  We gave her medication to make her sleep and took a look.  Her throat had a faint laceration where the bone had passed leaving its mark.  The scope was withdrawn, the procedure done.  Midnight had arrived.  I went home to my favorite meal here in Cameroon, Spaghetti.  I ate and crashed.  Morning would soon be here.  But not before another call by the hospital for the next to last patient who was bleeding through his nasogastric tube.
We see a variety of issues from mundane to exotic.  God helps us with them all, knowing what is best to do with what we have.  We praise Him for His Love and compassion towards us!  In His Care and Embrace, Greg

#110 Shanksteps

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