Im waking up shortly after dawn now which is my preference. So i guess my brain has finally changed time zones. I think it’s about a day per hour of time change to feel normal again. I feel cool- wow that’s awesome, it rained in the late evening and it doesn’t feel hot. i guess my body is changing temperatures too. I don’t know a time frame for my body to acclimatize. A couple weeks I think. I drink a lot of water in the morning preparing for the day of surgery. So I down about 1.5 liters. Then head to the hospital worship. though they speak french and I have difficulty understanding many times. If someone is speaking to me I can communicate and understand. After worship I make surgical rounds on my post operative patients. I see about 20 people in various stages of their convalescence. Some are there only for dressing changes as they heal their wounds from a wound infection. Ive seen all the wounds the first day so I let the nurses do the dressings the rest of the week and just tell me if their concerned about one. The prostatectomy guys all have bladder irrigation going and I decide who to stop and who to slow down.
Then on the the crowd outside the OR. People gather there that are family of those going to be operated on and also people who have paid the about $3 if they saw the nurse first and got whatever the nurse ordered in labs, or $12 if they only want to see the doctor. I greet the crowd and some thrust their little medical booklet towards me. I assure them that the nurses will get their “carnets” shortly.
in the OR things seem to be moving slowly and the patient is still getting IV fluids before their spinal anesthetic. The 22 year old that had agreed to a hysterectomy the other day after what appeared like a cancer in her uterus- has now refused because she wants to have more children. So as they get ready the old guy with a bladder tumor, I go and talk to her. I get my little ultrasound out and re-verify that I think it’s uterine cancer. I see what is in the form of a uterus and appears very irregular. So again I recommend a hysterectomy, for her health, and tell her she I doubt she could have a child with this uterus and that it will kill her with time and we should remove it. She and her husband hear me out and eventually decide to proceed with the hysterectomy.
An old guy with a tumor in his bladder that was seen on ultrasound is prepared and I operate on him. I ultrasound him a few days ago as well and saw what they had seen and so I chose to operate. I make a vertical incision because i may need more exposure to take out the tumor. It’s more anterior which should make it easier to get to than one posterior where the entry and exit is to the bladder. I open his belly and go into the bladder. Looking around inside- it looks very irritated but not anything that seems like a tumor, no stone, no thickening of the wall that is palpable. So after really opening it and really looking around I decide just to close him back up and treat him with antibiotic for cystitis (bladder infection). He was given blood at the beginning of the surgery because the anesthetist was worried about a lower hemoglobin of ?8. I thought we should wait and see if I got into bleeding, but he gave it anyway. I didn’t force the issue. At the end of surgery he started to ooze from it seemed everywhere. I thought of a reaction to the blood he received, causing his blood not to coagulate, so I texted the group of doctors here, and surprisingly it went through. (we’ve had very spotty cell service since being here this time). they said we had dexamethosone as the steroid and cimetadine as an antihistamine. So we gave him both. I check on him later in the evening and he appeared to be doing well.
The young woman with a uterine cancer I take next to the operating room. Her uterus is up to her umbilicus, that’s about the size of a 20 week pregnancy. She gets the spinal then is prepped and I open her abdomen. Upon entering the abdomen, I find a large mass. Then I see some dark blood in the abdomen. That’s not usual for a cancer. Omentum and small bowel are stuck to the mass. Slowly I free up the connections. I then realize there is a small uterus stuck to the front of it. So this is not the uterus, it must be a ectopic pregnancy. this make me very happy! An ectopic pregnancy (pregnancy outside the uterus) is only happy in this one instance, at least i can’t think of another time. Now I will be able to leave her other tube and ovary and her uterus and she will have a chance of getting pregnant again. Having children is the value of women here, so real important to them. So I take out the bleeding ectopic and then the oozing won’t seem to stop. I packed the pelvis and waited 5, then 10 minutes. Still oozing, so I ask if we happen to have surgicel, which looks like a gauze that stops bleeding. We do have ONE! (I will need to remember to try and ask and see if I can get any from my hospital at home if we can get any surgicel for here). I pack it into the pelvis and pack again, then when I check again it appears much better. So i recheck the other places I stripped off, wash out the belly one more time and close.
In between surgeries I go out and see some consults in the pre-op/post-op area. A guy is there with a tick in his ear. I say how do you know its a tick. He only answers that it is. So I go back into the OR and ask if we have an otoscope. I look in his ear and see half a tick and legs off that side, and it’s walking. I ask him if it hurts, and he says it’s not bad. I ask for some long sinus forceps. Im able to reach these in and touch it. This is a very sensitive area. I tell him not to move and he doesn’t. I can tell Im really hurting him but don’t know how to make it better but to get done. I try to grab a leg unsuccessfully. Finally Im able to pin it against the tympanic membrane and grab it and pull out the tiniest tick Ive seen. He was incredibly tolerant of my getting it. These people are amazing for their pain tolerance. We have NO narcotics here. So no matter what surgery I do- you get ibuprofen and tylenol, try that on your next surgery!
The last one I start at about 5 PM and it’s an ostomy reversal, so I know it will take a couple or more hours. Their belly is prepped, and I incise around the two lumened ostomy. I free up the tissues down to and through the fascia. As I pull it up to start to make the connection of the two ends, the appendix comes up too. Well I guess I’ll take that too. Then they won’t have appendicitis in the future. i make an anastomosis with multiple stitches, about ?50. Then I take off the appendix. I finish a bit late for the worship that is happening at one of the other missionaries houses. But I go check on a couple patients and go over there anyway. They hadn’t really started yet, so I get to attend all of it after all.
At home I have rice and beans that were prepared earlier that day and then shower and go to bed wet- hoping that I will be asleep before I evaporate. I do, and don’t get any calls and get a good nights sleep- thank you God!
Shanksteps of Faith #4