Am I too jaded, calloused from being overseas and seeing too much death and terrible diseases? I think I want to feel what Jesus feels when He looks at our pitiful state here on earth. I want to have His compassion and love for those around me. And partially I do, but I also have gotten more calloused, maybe a protective barrier to patients plights in Africa.
Yesterday I evaluate a girl who is 14. she is a thin girl with a gigantic breast mass that is painful. She has a history of some kind of cancer that was diagnosed during an abdominal surgery. A piece was taken to Poland and pathology from them just came back with B-cell lymphoma. she came in this time because she heard on the radio that I was here. She wants the painful breast removed. As i see her, I note a huge breast on one side and a tiny one on the other. I feel her abdomen and she has masses in there too. I’m sad as I evaluate her. I don’t know if a mastectomy will help or hurt her. No chemotherapy is available here. It may help her pain for a while but will it heal? It does seem a little mobile from the chest wall, and that may be a good finding. Or it could be attached to the muscle and the muscle moving. I tell them I’m willing to do the surgery and give them the most likely postoperative events. Today she is laying in her bed just holding her hurting breast, stone faced without a sound. When I ask she says it hurts. The dad is in Ndjamena and they are waiting for him to send the $80.
Another one came in because they heard I was here, and she has a mouth tumor that has been present for 2 months. She appears about 10 and the tumor is on her lower teeth and is about the size of a medium sized lemon. I run my finger around it and it starts to bleed. I give her a gauze and she spits blood for a while, while they hold pressure. She also has a few enlarged submandibular lymph nodes. So likely spread to those as well. I don’t know what this would be but would be awful to have that in the front of your mouth bleeding and making it difficult to eat. I plan on taking this out tomorrow, and Im worried about blood loss, and how soon it may come back. God help me do what’s best for her!
Todays surgeries were a prostatectomy, an abdominal hysterectomy on a old lady with uterine prolapse, an involcrum window and trying to drain pus of chronic osteomyelitis going on 10 years, and exploration of a guy who presented with peritonitis. He had 3 days of pain and yesterday intense pain everywhere. The ultrasonographer thought of appendicitis. I’m thinking , it could be: appendicitis, typhoid perforation, gastric perforation, perforation colon…. So which incision to make. We need a CT abdomen. Instead i’ll do the Chadian Digital CT. Digital (finger) Cut and Touch! So we fit him in between the other surgeries. In the OR Phillip puts in a spinal and David puts in a urine catheter and preps the abdomen with butadiene. I wash my hands with the bar of soap that is available. No other hand scrub is available now. I make a midline incision in the center of the abdomen as I don’t know wether I will need to go higher or lower as i don’t know what’s really happening inside. I get a little bit of pus when Im in the abdomen. I feel around and feel an enlarged appendix so I extend down the abdomen. I can see that the side wall of the appendix is blown out. So after freeing it up, I tie it twice and take it off. then I make a purse string around it with suture and duck the stump in. Then we (Ted an family practice resident and I) irrigate the abdomen a lot with saline. Once the fluid we are sucking out of the abdomen is clear we close.
I go home an find a number of people in our home. There are many short term volunteers here at the moment. a couple are physical therapist, a PT, a couple family medicine residents, and then the missionaries that are here. We have hired a guy to cook a meal in the evenings for us so that when Audrey and I get home from the hospital there is food to eat. So we asked this guy to make more for about 10 people. So we are eating in the evenings with a number of people. It makes for better community and a meal is sure nice when we are done with work.
