Bere 2018 #22
I’m on the plane from NDJ to Addis Ababa. It is just sundown and two seats behind me and to the other side, a Muslim man starts what to me sounds like the Islamic call to prayer. He sings the song for a number of minutes. Maybe its more than the call to prayer maybe it is the service that they normally attend. As a non-Muslim, I’ve never been inside a mosque at the call to prayer, though it does interest me.
The day before yesterday I did rounds with Dr. Sarah on maternity and told her about the patient with the tracheostomy and what I thought would be a reasonable timeframe to take it out. I wanted to let her know what I was doing and had done for a few so she wouldn’t be in the dark after I left. In the early afternoon I took a kid to the OR that had broken his leg in January. It must have been an open fracture based on the fact that now, bone was sticking out. He had been unable to walk for about 3 months, then was able to walk, At this point he is walking and playing football (soccer). He is about 8 years old, and has shorts on with a handkerchief wrapped around his mid-lower leg. I unwrapped the handkerchief, and saw about 6 inches of tibia. The upper end was sticking out a little, the rest was exposed with a bridge of skin about an inch wide in the middle. It seemed firm, but I suspected that if I took him to the OR, enough time had gone by that I’d be able to remove it. I suspect a sequestrum. That’s when your body takes an infected piece of bone and starts pushing it out over time. The bone behind or the periosteum can create bone behind that allows the person to have an intact bone. Healing behind the infected piece. So in the OR, he was given ketamine, and the nurse prepped his leg with betadine. After it was prepped and draped and he was asleep, I cut the skin over the middle. Then we grabbed the end that was out the most, and it seemed a little mobile. I rocked it back and forth. I realized that a spike of bone was still under the skin in the upper area, so I cut the skin above that spike. After releasing the spike the rocking motion easily dislodged about a 6 inch piece of the anterior tibia. Behind was all granulation tissue. Dressing changes should help him heal this nicely. A dakins dressing was placed and off he was to the preop/postop room to start to wake up.
Next was a 15 year old kid with a mass on his foot that had been there about a year. He said a piece of wood had stabbed him there before. I suspected a reaction to retained wood pieces. The mass was on the top of his foot and was about 1.25” across. I expected to have to leave it open, but I was able to get the skin closed with some tension. He was pleased that I was able to close it.
I thanked each of the OR staff members and thanked them for their work. As I grabbed my bag and walked out suspecting this was my last surgery in Africa for this trip. Then they said I was needed in the ultrasound room for a suspected ectopic pregnancy. I put back my bag and head over there. As I look at the ultrasound screen and run the probe over the woman’s belly, I realize it must be an ectopic (extrauterine pregnancy). So I write orders and send the husband to the pharmacy to get medicines and send her to the OR to start getting her fluids so a spinal can be done. After the spinal Dr. Sarah and I opened the lady’s abdomen, and as I described in previous posts, there was a lot of blood! Three to four liters of blood came out in the suction canister, all over the drapes, and pudlded on the floor. She was getting blood as we started, and I could see welts starting all over her. She was having a transfusion reaction. They haven’t really started crossmatching blood yet. Though apparently the lab has just learned how to do it. We gave her dexamethosone, gave her a benedryl tablet under her tongue and I wondered whether she would go into DIC (a bleeding disorder) from the transfusion. Her hemoglobin was 5 before any dilutional effect. At the end of the surgery Dr. Sarah tells me there is a woman in maternity that had a C-section before and is trialing for a vaginal birth. If she stops progressing then she will need another C-section.
Back at home I sit in front of a fan and sweat! It feels real hot tonight. Finally with sitting and cold water I stop sweating. I take a shower and head to bed wet, hoping to fall asleep before I evaporate. I do fall asleep and about 1 hour later am awakened by a knock at the door. Someone who has been stabbed in the back, is in the ER and I need to evaluate them. I grab my headlamp and head in, expecting to need to operate, they don’t make short knives here. So I anticipate internal injuries. I see a young man writing around in pain with a crowd of about 20 onlookers. He stops writhing as I examine him. I see a small ½ inch hole just to the left of midline in his lower back. I also see a ¼ inch hold that is in the midline. Did it hit his spinal cord? Either way I cant do anything about it, but I’m curious. He seems to have normal sensation in his legs, but pain on one leg more than the other. I prep both areas with betadine and grab a needle cover to probe the wounds. The one in the middle goes straight in about ¼ inch. The other one goes in about 3 inches but runs just under the skin. I decide to leave both of them open with a sterile dressing. Give him antibiotics and tetanus vaccination and expect him to get better.
I go to maternity to see how the woman is progressing with her delivery. Dr Sarah is there and the patient isn’t progressing. So to the OR we go. We get a live, crying baby out with lots of meconium (baby poop, meaning fetal distress). I head to bed about 2 AM after another shower to get the blood off me and cool down again. We are scheduled to leave at 5 AM for our trip back HOME. It was a short night!