Shanksteps # 132
I knew it was going to be a tough day. We had just finished a C-section at 2:30AM. Took a shower and headed to bed. I drug myself out of bed at 6AM. I made hot chocolate and had my own worship, arriving at the hospital at 7:30. I had a colon cancer to resect today and was worried about it. I had diagnosed it on colonoscopy back in February. He was the head nurse of a health center and had decided to try traditional therapies. Now after many months he came back to have it removed. In Maroua (three hours away) they had asked him $400 to remove it. Here I expected it would end up being about $200. Money isn’t really an issue for him, but he chose to have it here anyway.
After morning worship and sign-out I headed to the office to see a few patients that were waiting there. There was the follow-up for typhoid treatment, a bad pneumonia with significant shortness of breath, a child with a cough for months and weight loss- possibly TB. There was a woman coming to follow up her hypertension, a teenager with a right inguinal hernia, and an old man with prostatitis. Finally there were no more for the moment so I “ran away” from the office. The office is kind of like the ER, if you are around their will always be one more question or one more patient to see. Audrey was making rounds on the pediatric ward with 28 patients (24 beds, some two to a bed). I made rounds on the maternity/surgical ward as usual. There were three recovering from prostatectomies this past week, three who delivered a newborn over last night, the girl that we did the c-section on in the morning. Others were wounds that were healing, a child with chronic constipation r
equiring rectal lavages, and the girl healing from her skin graft following a burn of 2 months ago. There was the boy who caught his fingers in the grinding mill, taking care of half of three of them, requiring a revision of the damage. There were two with endometritis after delivery at home and two with threatened abortions after working all day in the fields; another with gonorrhea PID who is pregnant. Finally we were ready to start the colon resection.
He was a large, short man. Unusual for most surgeries here, he had a number of inches of fat to go through before reaching the inside of the abdomen. Intestines and omentum spilled out as he tensed his abdomen. Ketamine (anesthetic), love it and hate it! It was taking a lot to keep him from moving. He did tell me ahead of time that he drank SOME! After exploring all over I did not see evidence of any metastasis. The tumor was low in his pelvis. I identified the path of each ureter. Mobilizing the descending colon, we ensured that there was adequate length to reach the lower portion once we had resected the tumor. After removing it, how would we put it back together? Normally I do a hand-sewn anastomosis between the two pieces of bowel. This was really to low. I thought we had one circular 29cm rectal stapler. So it was found. I hadn’t used that style before but was able to create a good anastomosis. Filling the abdomen with saline (to look for air bubbles – l
ike looking for leaks in a tire tube) the anastomosis proved airtight. Four hours later we were done. (seems so easy here, one paragraph!)
I dropped my operating stuff off in my office. Saw a few patients that were waiting for me. Amadou called me to see a patient in the ER. It was the son of the Sous-Prefets assistant. He had been by the road and hit by a passing motorcycle. He was conscious and had a wound on his right head behind his ear. Grey tissue was in the wound. Oh this looked reminiscent of a few months ago. I put on gloves and examined him. Some scrapes and bruises were found on his legs. His head had a depression that my finger could sink into. Pupils were reactive. He needed to have his open skull fracture debrided and closed. I called Jacques to come give anesthesia and ran home for my first meal of the day, it was 6:30 PM. I inhaled some potato fries and salad and went back.
After putting him to sleep, I opened up the area on his head. The skull had been punctured and many fragments bent into the center of the hole, grey and white brain tissue pooled in the area. With difficulty I removed or elevated 7 pieces of bone. During the process one artery was uncovered that bled profusely. After a struggle I was able to tie it off adequately. I could not find enough dura to close. I created a patch out of temporalis fascia and sewed it in place. Placing a drain, I closed the hole. His pupils were reactive and we sent him back to his room to wake up.
“Doc, can you see this woman in maternity?” It was Amadou again. A woman was in labor at home since early this morning. She had been “worked on” and had a very edematous perineum. The baby had sounded good to him. Oxytocin had been started to restart labor. Now she was having abdominal pain. Examining her, there seemed to be enough space for the baby to come out, but I found no baby heart beat. I ran to get the ultrasound. Baby was head down and the heart was not moving. I thought I could see the placenta laterally but wasn’t sure. I attached forceps and tried to help the fetus come down. It seemed unsuccessful. Then I realized that she had ruptured her uterus. So back to the OR we went. After 30 minutes we were deciding whether to repair the uterus or was it too damaged. She had told me she didn’t want more children. It was fortunate because it was very damaged and we needed to remove it.
Yaouke came in and mentioned that we needed to see another kid when we were done. She had eaten a meat sauce with a bone in it and felt it get stuck in her throat. She had a lot of salivation and couldn’t swallow. We finished up the operation. It was 2AM. We pulled in the girl to the other OR. After writing my operation note, I went and did a laryngoscopy. I could not see anything unusual. I prayed that she would not have any real problems.
I arrived home, showered and fell into bed. It had been a long two days. God give me the strength to continue. Give me patience even though I feel very short tempered.
Counting on HIM, Greg