Shanksteps (of faith) Bere 2017 #10
It’s Sabbath. The day I worship our creator God and spend time with Him and family. I like to avoid work (hard to do as a doctor) and here we don’t do rounds, but will address whatever emergencies show up. It is a camp meeting weekend so there is no local church today as all are off to a village about an hour away for the day. Christian and Sabrina are having a brunch and worship at their house, so I go over there after reading at “home”. There is a smattering of dishes to eat as there are many nationalities amongst the few of us there. There is mata (an Argentinean tea that is shared with a communal cup and metal straw), Cameroonian peanut sauce for rice, Argentinean crepes, Guatemalan salad. I didn’t bring anything and realize I should’ve come up with something even though I’m a poor cook. I could’ve brought a dessert of granola bars or something. We listen to worship music and eat brunch. We then get a call from the hospital guard to come and see a patient that may have appendicitis. After the meal Christian and I head over there. A mid twenties, very muscular guy is laying stiff on the ER bed with sweat all over his forehead. A grimace is on his face. He is in obvious pain and he answers questions laying perfectly still. He’s been sick for about a week, but yesterday the abdominal pain became much worse. I touch his belly that is rigid and he grimaces each time I tap on his abdomen. I guess he, like many others this week, needs a digital CT (cut and touch). I learned this term from Christian and am enjoying it here more and more. Mostly for the duplicity of it’s meaning. I’m thinking it could be appendicitis, perforated typhoid, perforated ulcer, or bowel necrosis from an internal hernia.
In the OR I open the abdomen and immediately bile pours out. This makes me think it is either stomach or small bowel. As I look around the small bowel is very inflamed and red. Looks like typhoid to me. I come upon a spot where bile is pouring out of the distal jejunum (small bowel). I freshen up the edges (make the hole larger excising the perforation), and close the hole. We then look at all the small intestine from beginning to end. There is one more area that is purple and very thin, nearly making another hole. So I excise this area and close it the same way. We wash out the abdominal cavity and close our laparotomy. He goes to the surgical ward. Since he had spinal anesthesia, I am able to talk to him as we leave the operating room and tell him what we did. He is thankful for our care for him.
I head over to the private ward as there was a father who asked me (in English) to see his son who hasn’t seen a doctor since he arrived yesterday evening. I asked what was happening and the father said “his stomach worry him and it take 4 person to hold him down.” I remember that a worrying stomach is a painful stomach as stated in Nigerian English. And whatever he has he isn’t in his right mind- ?cerebral malaria, ?meningitis, ?advanced syphilis, ?hypoglycemia, ?stroke… the list is endless. The physical exam is my only diagnostic. The treatments are limited, so I’ll call it something I can treat and treat it.
As Christian and I walk up to the ward, an overweight man greets us in French. He is one we operated on recently and has a urine bag hanging out from under a wrap around is waist as a skirt. So I assume we did a prostatic surgery on him. He says he has some drainage that started today and opens his skirt. I see a low midline incision an Christian remembers that he was a prostate resection. He has pus coming out of his lower incision. We tell him to go to the operating room and we will be there in a few minutes to take care of it. We walk into the other guys room and see a about 17 year old being held down by 4 others. He is wide eyed and thrashes about. He then relaxes for a minute or two then thrashes about again. His malaria test is positive, so I suspect cerebral malaria. He’s been treated in Moundou, the second largest city in Chad. I’ve heard from people there that the medical care there is terrible, so I don’t assume that he’s been appropriately treated. We order the things to treat him. They thank us and we head back to do a dressing on the other guy in the OR prep room. We open his lower incision and some pus comes out, he screams like we are killing him. Very much unlike everyone else here. He is apparently a chief of a part of a nearby town Kelo. He is also heavier than most of the local people, which confirms his chiefdom in my mind. Christian numbs him up before proceeding further. He tolerates the rest better and is happy when he leaves the dressing change. I head back to my room and write/read/rest. It’s been a good Sabbath. Jesus healed the lepers on Sabbath. I closed the holes in some guys bowel, and Jesus will heal him too.