#134 Shanksteps
I walk into the hospital not quite feeling all-right. Audrey asks me to stay home, I won’t! I have had a runny nose and feel achy all over for two days. I did the malaria test and typhoid tests, both of which were negative this time. The day before I did not have the stamina to last all day like usual. So I decide at least I will go in and make rounds on maternity/surgical ward as I usually do. I feel tired but know I can at least do this. I woke up with a fever of 102*F. Now it has come down after some Tylenol. I make rounds, sitting down often on the patient’s beds to talk to and examine them. After rounds the administrator asks me to do one administrative thing with him before I go. He and Audrey are in cahoots to get me out of the hospital. I’m not entirely full of “fight” anymore and decide to go home after helping him. Then there is the all too frequent call to the urgence (ER). Kalda has a patient who he thinks I need to operate on. So I saunter over the
re.
The teenager is lying on his back with abdomen exposed. He is a thin guy but has a very protuberant abdomen as I see him. He has slightly sunken eyes. I feel for his pulse and it is rapid, I count-128. His father has brought him into the hospital after being berated by one of our nurses to come in. He has been at home 4 days without any bowl function. He is completely obstructed. I find no hernias, no previous surgery, and no starting point for the pain. The history taking is less than optimal, but as I re-ask he questions I’m getting no further. I give up and examine him. He is tender to palpation and as I thump on his abdomen he winces in pain. At least it is clear what I need to do’ Operate! I have them send him over to the OR and ask Jacques to get him ready. He calls me a half hour later saying all is set to go. So I meander to the OR, gulp down some water and scrub.
We pray for him, as we usually do before starting surgery. I open his abdomen, skin, minute amount of fat, fascia, peritoneum. Dark purulent fluid runs out. I’m glad I didn’t let my own feelings keep me from doing what I needed to for him. As I open further his intestines burst from the incision, being liberated from their confinement. As I explore inside I find a black piece of tissue in his lower abdomen with stool coming out near by. I realize that his ileum (last part of the small intestine) is necrotic and isn’t even visible as a structure any more, but on both ends of where it used to be there is open small bowel and the same where it used to be attached to the large bowel. Everything else is dark and has the characteristic red rash appearance of typhoid. Typhoid is likely the real culprit. I bring out two ostomies because of all the fecal contamination inside. We irrigate repeatedly, but then again, what can really get rid of this contamination? After clos
ing and putting ostomy sacs on the ostomies he goes out to his room. I sit to write the note and suddenly feel very tired. I go home, have a fever of 101.5 and sleep covered with many blankets even though it is 90 in the house.
I am comforted by the fact that God gave me the strength to make it though the surgery even though I didn’t think I had it in me!
In His Service, Greg