An older woman sits in front of me in clinic, her husband on the chair beside her. She says that something is coming out below when she walks, and has ever since she had her last baby a few years ago. I examine her and find it’s her uterus coming out
Another young man is having rectal bleeding for the past few weeks.
A third had an accident on his motorcycle a couple days ago. The huge swelling on the side of his face is improving. He arrived unconscious and now is thinking clearly. He says that one tooth doesn’t seem to be in place. I examine him closely, and find that he has a mandibular (jaw bone) fracture right before his last molar.
These are the surgeries for today. The older woman took her bowel prep which consisted of a bowel stimulant (Bisocodyl) and water. She is placed on the operating room table. The preparations are made and I put on my cloth operating gown. It’s cut real small for my long arms, and when it get’s wet with blood or other fluid, I’m wet with it too. I help Dr. Solomon put his on, as I’m particular about sterility even though others don’t seem to see the necessity of all that I do. This is probably the cleanest she’s been in 60 years of life.
I open her lower abdomen. She has essentially no fat! I open the skin down to fascia in one fell swoop. Cautiously enter the fascia and peritoneum. I search her pelvis for the uterus. I grasp it between my fingers and pull it into the wound. It has been prolapsing so far that it comes up easily. It turns out to be one of the easiest hysterectomies I’ve done. I didn’t bring large enough suture to do hysterectomies so use a smaller than normal one. For her tissues it turns out fine.
The next was the young man for a colonoscopy. I finally find the colonoscope again and all the things that go with it. I look inside and find a very inflamed intestine. Colitis.
The 30 year old guy with the mandibular fracture is next. I take him to the OR but cannot find the materials I need. I need arch bars (metal bars for the teeth) and wire to attach them to his teeth. I need to wire his mouth shut for two months to let things heal. After opening a number of sterilized packs, I finally find the one that has the right equipment in it. I wire the arch bars to his teeth then, the arch bars together. I find that I cannot include his last tooth so the fracture is still loose. At the end I realize I will still need to wire his bone itself together as I don’t have any metal plates to put on it. I’ll wait till the swelling goes down then attempt to finish.
I return to the clinic to finish seeing the patients that have been waiting for hours. See more malaria, typhoid, pneumonia, and another malnourished kid who is 2 and weights about 14 pounds. I head home to a meal of millet paste and sauce (my actual favorite here). G