Disaster Response B #11
I’ve been called in the past two nights to operate emergently on someone. The night before last I went to bed. About 1 hour later I awake to a flashlight in my eyes. I didn’t know whether to go towards the light or away… I realized eventually someone was waking me up. Eventually I got up and headed in to the ER. There was a lady who was about 5ft 2in weighting approximately 350lbs with a painful mass in her mid abdomen. The ER doc had given her sedation with Versed and tried to reduce the hernia- without success. So I tried- unsuccessfully. So we called the OR crew in and headed back once everything was ready. After the anesthetist put her to sleep I made a midline incision. I was able to dissect out the hernia sac fairly quickly, but it wouldn’t reduce. So I opened into the area of the intestines and slowly divided the tissue up to the small “neck” of the hernia. Eventually it was open and still it wouldn’t go into the area of the intestines. So I slowly opened the sac. I was now able to see that it contained omentum (the fatty layer inside) and not small intestine like I expected. So I took off the sac with it’s omentum inside. The intestine I could see looked good so I didn’t think any intestines were damaged too. I closed up her abdomen, and since I didn’t have any large piece of mesh, I closed it with sutures. Her recurrence rate will be higher, both from the size of the hernia and her size.
Last night I went out with about 15 people they were willing to take to the ocean at around sunset. This late hour was because the day nurses and staff don’t get to go out if they go any earlier. I discussed with the ER docs if they minded if I was gone for a little while. They figured they could deal with whatever till I got back. It was a very nice evening. I hadn’t been off the tent campus since I came a few weeks ago. As we drove about 10 minutes away, we passed lots of houses. All of them had a pile of furniture, dressers, cabinets, mattresses and random other things sitting in a huge pile on the side of the road. These were the destroyed items to be picked up by the garbage service. (as an aside- I talked to a man this evening that said he lives a little way from a town of 300. He said that they know of 17 of that town that died and that all the houses- you can stand at the front and see through to the back yard.) Back to our trip. We passed some apartment buildings about 4 stories tall, that the front wall of the apartments had been blown in to the rooms. The roof of the apartments were partially gone. Stuff lay strewn all over the ground. We went past the KFC and past a bank and other important looking buildings that didn’t appear to have much damage. We got to the beach about sunset. I walked out on the sand and the water was very calm, the reef is far out and there was no wind. I waded out into the water about 100 feet, and it was still about 3 feed deep. I sank into the water and just enjoyed the last minutes of sunset in the sky. A while after the milky way was out, we went back to the bus and headed back to the hospital campus.
As I arrived I was told I was needed in the ER. Someone with a suspected perforation (hole in the intestine) was there and I needed to operate. I found two of the local surgeons there, and they said a patient with free air (air outside the intestines- from a hole) was across the street having gotten a CT scan, and would be on their way to us. It seemed like it took forever. And in a way it was, because two hours later the patient arrived by ambulance from ACROSS THE STREET-literally! So the three of us surgeons took him to the OR. I lead out since I’m the one to be operating here. He was about 27 and had had epigastric pain and had been taking a lot of ibuprofen. So I suspected a perforation from a stomach or small intestine ulcer. In the operating room I cut open the upper abdomen. The peritoneum was distended with air. Opening further I found a lot of cloudy fluid. Looking around through the intestines and stomach, I found a small hole on the front side of the stomach. The edges of this have poor tissue to fix, so I cut back further around the hole. This made it larger but got to good tissue to close. Then I sewed the hole shut. Next I took a piece of omentum (fatty layer in the belly) and put it up over the hole and sewed it in place. I consider this a double or reinforced repair. We got done in the OR about 2 AM. I slept fitfully for about 3.5 hours till everyone in the 30 persons’ tent, alarms started going off and they started rustling around and turning on the lights.
I went in to check on him and the first thing he says to me is “Doc, I’m hungry!” He was adamant that he be able to drink and eat. I explained to him that he would not be eating for days. He didn’t care for that at all, but I think over the day he’s become resigned to the fact._______________________________________________