Shanksteps Bere April 2023 #4
Today is Sabbath, we go to church. I woke at dawn about 5:30. Fortunately they didn’t turn off the generator this morning, so I lay there in the fan for a little while. I get up and drink a liter of water and shortly thereafter Im thirsty again. I drink lots of water all day.
I go in to see the surgical ward before going to church. I ask the on call nurse if there are any concerns and there aren’t. So I go with the nurse and the students to the one patient I want to do the dressing on- the teen with the neck infection where I can see all the muscular neck anatomy I talked about last shanksteps. He still says that when he swallows that fluid comes out his neck. I change his dressing and see a fair amount of pus and saliva on it. Though that is a little difficult to tell exactly. But i have yesterdays experience to know that’s so. I change the dressing and then talk with him and the guy with him that we need to place a feeding tube. They seem to understand, but the ones that can make that decision- the older brothers- aren’t at the bedside. So I will need to explain it again later to them.
It’s another sunny, hot day here. At 8AM the temp on the little thermometer I brought reads 94. I don’t feel sweaty as long as I’m not moving and sitting in front of a fan, but know Im evaporating constantly.
I go with the Netteburg to the church with the kids under the mango tree. We drive there in the truck with me and the kids standing in the back, sun beating down on us. It’s nicer in the breeze than the inside of the truck i imagine. People walking along the road are enveloped in the dust cloud behind the truck. Little groups of kids playing under trees near the road wave and yell “nasara” their word for white person. Nnaasssaaarrraaaaaaaa….. It takes about 15 minutes to get there. We pull up under some large mango trees and kids and adults flock around. As we get out of the truck they ask if I’ll tell the kids a bible story. I’d like a little more time than that to think, but agree to do it anyway. Olen starts with singing with the kids songs that they have sung many times. the kids join in exuberantly with singing and the motions. When they are done singing, I tell the biblical story of Jonah and his hearing from God what God wanted him to do and Jonah choosing to do something else and run away. And how God saved his life and brought him back to doing Gods will. It took about 15 min with the translation and me speaking in French. Denae repeated the story with questions along the way and the kids were very excited to respond with the answers. Each kid who answered got a sticker. They were very excited.
We drove back home and hit a few dust clouds too as we passed some larger trucks taking the same road. It appears they are doing some sort of road repairs. It’s a weird time to do dirt road grading and repairs just before the rains start and they get destroyed again. At home it’s 110 outside and 100 inside.
We gathered early afternoon for a potluck meal. Food was excellent as I always find it at potlucks. And as far as I could tell everyone had food. We were thinking about walking around afterwards but there was a patient that needed to be watched as her labor progressed so we didn’t go out, had good conversations and played with balloons with the Netteburg boys that were left over from the wedding party.
Later on there is a patient who came in pregnant and wasn’t progressing and was found to have a dead fetus. She was followed and given pitocin and still didn’t progress. So when a C-section was needed, I offered to do it, so the other doctor could have some rest. Olen did the anesthesia and Douri assisted me. The baby’s head was high and not descending. She had received enough fluids via IV so Olen placed the spinal anesthetic. We prepped and dropped her abdomen and I did a phanynsteal incision (low transverse above pubic line). I went in through the skin, fat (very thin), and split the rectus muscles opening into the peritoneum. The uterus looked normal. I opened it in the lower section transversely. It was difficult to get the baby out. I found the head was large and deformed. So the head was likely to big for this woman’s pelvis. I put clamps on the uterine edges to slow the bleeding. Delivered the placenta, then started to close the uterus. After controlling the bleeding spots, I saw a hematoma forming on the left side. I opened the hematoma and put some sutures there. The left uterine artery had torn when I pulled out the large head of the baby. When there was no more bleeding then I closed the rest of the layers of the abdomen and she went to the maternity ward.
After a night surgery it takes me a while to wind down to be able to sleep. Im able to text with my wife at home and finally when I feel tired I go to bed. I got in bed around 1AM and lay there till about 3AM my brain going about random things- frustrating! At 5:30 IM called about the patient with his neck open with infection. He is bleeding from his neck again. I race in and find he has about half a liter of blood clots in a basin in front of him. It is coming from his mouth and doesn’t appear to be from his nose nor his outside neck wound. Is he bleeding from his jugular vein? I can’t see anything in his mouth bleeding and don’t think looking in his throat would help me even if I identified the spot on the inside. I wouldn’t be able to stitch it… It appears to have stopped, so I order a hemoglobin and send the family to be tested for blood type in case we need to give him blood. His previous hemoglobin was normal at 15.
I try to sleep again but it is impossible. I am never able to sleep in the daytime.
God give me Your wisdom to know what to do with this boy. Help him to stop bleeding. Heal his terrible neck wound. Help this boy to know Your love for him, and use me however you want to use me.