I walk into the OR (operating room) and they tell me that my patient isn’t ready. It’s 10:30, and they’ve had plenty of time (since 8AM) to get them ready. Im frustrated but hold my tongue. They don’t llke to work late but also don’t start at any reasonable time either. I go back out to the pre-op area to see some consults that are waiting while I wait for them. I see a 8 year old girl with a huge cystic mass under her armpit. It’s not painful and has been there about 8 months. The cyst is getting larger and they want it taken care of. What is it? I don’t feel any nodes anywhere. I ultrasound it and it seems like simple fluid with a couple small solid areas in it. Is it a cystic tumor? She has not been injured there nor any infection there. So i offer to take it off, not knowing wether I will be helping her or not. I don’t think Ill be hurting her.
I go back into the OR and Philippe has my patient intubated and asleep. The patient has a transverse colostomy. About 8 months ago he was in a town on the border of Sudan and was stabbed and had the ostomy placed at that time. His records don’t show how much intestine is left nor where along the intestine the ostomy is so that I can plan what to do. So blindly I start the surgery. I go through the previous scar and get into the abdomen. I’m into a lot of adhesions. All of the scissors in this package are horrible. none of them can cut the tissue Im trying to cut. I ask if they have any scissors that work and they only find one pair of eye scissors. they were very small, but they cut. After a while of cutting scar tissue, I found they had brought up the side of the transverse colon as the ostomy. Likely the area that was stabbed. I was able to take this down and make a repair.
Another consultation conundrum was a 22 year old guy with a huge neck cyst that was very soft. It started at his jaw angle and went down to his clavicle. I ultrasounded his neck and just fluid. What is it? I have no idea. So I take his number and will see if we can come up with something and then decide whether to take it out or drain it.
The next patient has lost their records from before and also has an ostomy. WOW, Im seeing so many ostomies here this time! I operate on her and cut the many adhesions to try to find out where the part of the colon is to attach this part to. After about an hour of searching I find what I think is the piece way down in the pelvis. I have one of the nurses in the room do a rectal exam and sure enough it is WAY DOWN THERE. There are no rectal dilators and no EEA staplers, and it is to low for me to make an anastomosis without this, so I have to abandon my efforts to try to reverse her. When I tell the family postoperatively, they seem unaffected. They ask if the smile train doctor coming in a month can fix it? I tell them he won’t have the equipment either.
It is now 5PM and there is a 40 year old diabetic with a gangrenous foot. I had seen him yesterday and asked the family to give blood and we would operate. One person tried but was Hepatitis B positive so I asked them to get other family members to give. We are still low on blood so we are trying to push all the operative patients families to give, this helps their loved one and also if we don’t use it- it helps the rest of the hospital for emergency needs. Abouna gets the patient ready and as he has been doing surgery before I came thought about debriding it. But he felt crepitance (gas in the tissues). This is a horrible sign of gas forming bacteria and can kill someone quickly. So I tell him a simple debridement of tissue won’t work and he needs his leg amputated below the knee. I also call in his brother and explain it to him. They say do whatever is needed. In the operating room we don’t have a tourniquet, so the nurse wraps two urine catheters tightly around his leg. He still bleeds a lot and I wonder if the tourniquet is just stopping the venous return but not the arterial flow- actually making it bleed more. I get down through the muscles on either side of the bone and then get the bone saw to cut the bone. This is a well used saw and isn’t sharp. Anna, a FP resident here for a few weeks, tries to cut and then I take over and with a lot of effort, I saw through the bone. I take a blade and cut off the rest of the muscles quickly and then control the bleeding. I leave the area mostly open as I want to treat infection and evaluate for crepitance in the morning.
Tonights meal is rice with a peanut vegetable sauce. I’m very hungry and it is delicious. Audrey and I sit in front of the fan for the evening and catch up on our day. We try to catch up each evening as this is one of the things that help us feel closer to each other. Then it’s a cold shower (that’s all there is, and also all I want) then off to bed dripping wet. Hoping I fall asleep before I finish evaporating. I awake this morning to some birds singing loudly outside my open windows before the sun has risen.