Bere 5/2025 #3
Ohhh power just went out as I start to write and get ready for bed. I certainly hope they figure it out or me sleeping without a fan will be very difficult!! Today was my second day of operating.
I woke up early and did the things of the last post. At 7AM I went to morning worship and then soon there after the power went out. I knew there was suppose to be a woman with a large thyroid to operate on this morning and that would take a while. There were some texts going back and forth about what was happening with the generator so I went to try and find out. I found a number of guys I don’t know. I guess they were newer than when I was here last year. One was the mechanic, who can fix about anything. At least he listed off a bunch of things. He told me that the generator stopped because the voltage was zero in the battery. He shows me a panel. It has numbers and digital readouts. So I know it wasn’t zero! He showed me where the panel said 0V, but it was under the heading generator. So the generator was off- thus zero volts. I asked him for a electrical multimeter. He said they were bringing it. I was around there another 15 minutes with lots of discussion. Finally they purged the diesel system of air and got a car battery and started the motor. It ran fine . Then they changed back to the “old” battery while it was running, putting the other battery back into the car.
I was suppose to round and the other surgeons operate. Then the first surgery, a large thyroid goiter was hypertensive. So the other surgeons cancelled her. So I was up for removing a young girls bladder stone. Phillipe the anesthetist put the patient to sleep with propofol and some inhalation isoflurane and bagged her with a mask. Her sat dropped temporarily then back up. I scrubbed and we prepped the skin and put on the cloth drapes. The nurse David had filled the bladder so it was near the umbilicus and then as I go in I will get into bladder and not intestines. She’s about an 11 year old girl so she’s quite petite. I cut through the skin low in the abdomen. Split the muscles and identify the bladder. She desaturates again, low this time, 40’s. Phillipe doesn’t have suction ready and he takes a bit to get it together. Im trying to let the anesthetist do his job but Im about to scrub out to help him when it starts slowly improving. I have a nursing student call in Dr. Andrew to assist. He’s doing consultations. The oxygen saturation is pretty good when he arrives. So I continue the operation. Andrew leaves and shortly thereafter the power goes out. I always wear a headlamp so I’m the only one in the room with light. I immediately worry will the patient desaturate and die for lack of the oxygen machine and anesthesia machine? I try to hurry up as I just ready to retrieve the bladder stone. I get it out and it’s about the size of filbert nut. The patient slowly starts to desaturate. I try to work as quick as possible. About the time she’s in the 80’s for saturation the power comes back on and she slowly climbs back up to normal in the mid 90’s. Wow that was stressful surgery. So many things out of my control and many can kill or make a bad outcome.
I go to see what’s happening in the other OR. I find a nurse doing a hernia repair with a nursing student. No one doing anesthesia. I asked him where is his anesthetist? Well he had done the spinal then started the operation. I told him I thought that was very unsafe, decided not to make further comments and tell the missionaries that are here. That way they can address it if they wish. It is quite different being in charge of a hospital like I was in Cameroon, vs visiting and trying to asses how to help without ruffling feathers.
The next one was a young girl of about 12 who had a broken leg about 3 years before and keeps getting infections in her skin. She has some right hip pain as well. So she had had an X-ray so I went to look at it. It shows and involucrum (a thickened irregular bone associated with boney infection) and likely a sequestrum- a piece of dead bone that is an infection source. The other doctors think this is the source of her various infections around her body. I have no other explanation and this definitely looks like it’s a likely source. In the operating room I open the outside of her hip bone and eat away at the soft bone down to the marrow. But the infection seems to have been replaced with normal marrow and not full of pus like is usually the case. So I wonder if I have missed the part with pus inside. So I open the skin down to the bone quite a bit lower on the femur. Here the bone is hard and normal and I can’t even make a window into it by trying to nibble away at it. I ask for the nurse to search for another missionary to come in and help with their thoughts. Two come and after discussion I decide to close up and they will send this info to the ortho friends they have to see who has better ideas.
When Im done with that David has done the other hernia case and there are no other planned cases today. 2PM- wow I don’t think Ive ever been done at that time. So plenty of time for emergencies to be taken care of. Zach and I head back to our rooms and get more water to drink. When we’ve cooled off a bit in front of a fan, we go to the small market area just outside the hospital and I show him the types of things you can get. We get some Gato (kind of like large donut holes) and sugar for them and for kool-aid I brought. We also get toothpaste, and some little things that look like kit kat bars. Back at my room we eat these and enjoy them.
Im called to see a woman in labor who may need a C-section as the midwife says the baby is having some decelerations (heart slows down- a sign of fetal distress) with the moms contractions. It’s this moms first child. I go into the delivery room where there are rows of beds next to each other for delivering women. There are two delivering women with many other women standing around. The nurse tries to get the women to leave and some file out. We ultrasound the one Im to look at. The babies heart rate is good and its head down with the placenta not near the exit. These are all good things. But the baby isn’t coming out. So I attach suction to the babies head which is right at the vaginal opening now. With successive contractions I try and pull the baby with the suction attached to its head. It doesn’t help much. It seems the babies head is a little to large for the pelvis of the woman. So the options are C-section or symphisiotomy (separating the pelvic bone symphysis to enlarge the pelvis). I was taught symphisiotomy by an old OB/GYN while in Cameroon and this seems like an appropriate patient. So I decide to do that. Zach goes to the OR to collect a few things for me and the midwife gets some other things. In between contractions, I place a foley (urine) catheter and then numb up the skin in front of the symphysis pubis (the connection of the front of the pelvic bone. I make a small incision in front of the bone and with the scalpel “feel” my way down to the ligament connection between the bone. I put my finger in the vagina and push the foley catheter to one side so its not down the middle. So with one finger inside the vagina and a scalpel cutting the ligaments I slowly divide the ligaments. When it’s near the end I can feel the blade on the other side of the skin of my finger in the vagina. If I go to deep I open the vagina and slice my own finger. There is a pop and the bone opens about a fingers width. The contractions keep coming and after the symphisiotomy the baby comes out in about two pushes. Wonderful! However the baby is floppy and there is meconium everywhere. I pass the baby off to the midwife who takes him to the side table and starts suctioning his lungs and getting him breathing. It takes about 10 minutes and more time on oxygen- but the baby appears to be doing well within about an hour with the midwife spending most of that hour with him. While she helps the baby to live I sew up my small incision with a stitch and the nursing students clean up all the blood, placenta, meconium and mess. I am always thankful to have a live baby – thank you Jesus! Also thankful that this woman didn’t need a C-section- meaning a scar on her uterus, that gives her an increased risk of uterine rupture in the future. Her pelvis will heal with a wider opening and her next delivery should be easier.
God help this baby to live and to grow to know You! Give me strength for each day and wisdom for each patient I see. Help me to support the missionaries here and help me to share Your love with all those around me. Amen
Attached a picture of bladder stone.
