Bere 5/2025 #5
Long night
I was told about 10 PM that the ambulance was gonna go out tonight to get a patient from Lai. At about 1130 I was called to see a patient that had intestines hanging out. I came into the ER and that’s exactly what I found. A 50-year-old guy with intestines hanging out his left side. Both large intestine and small intestine and a whole bunch of poop. He had been stabbed with a cow horn. There seemed to be no further history than that. He said that he did not hurt anywhere else. So I called Phillipe the anesthetists and we went to the operating room. The ER Nurse had started two IVs, and then had put some Dakins solution over the exposed intestines that had poop all over them. After the patient was in the operating room, I tried to call my nephew Zack a number of times and he didn’t pick up. So I went to his house and beat on the door. Apparently he was fast asleep. So I shown my light in the window and beat on the window and eventually he woke up. He came to help me with the operation. In the operating room, the 50 year old man was intubated by Phillipe and then I prepped the abdomen and prepped all the intestines with Betadine and tried to wipe all the poop off of them. The size of the intestines and omentum that were out of the abdominal wall were approximately 8 x 10 inches in size. He was hypotensive from the start. His heart rate was good, but his blood pressure was low and he’s been in septic shock ever since.
I take a scalpel and open the skin along the midline lower abdomen. Through skin, fat to the fascia. Then into the abdomen. I get a fair amount of blood and suction what I can and the rest spills from the patient down the sides of the table. With in a short while I feel his blood has seeped through my cloth gown and through my scrubs to my skin. Yuck. The intestine has been stuck outside since this occurred at 5PM (I found out later) and I’m operating at midnight. So the intestines that are stuck out are a bit purple and hard to get back inside. After I work them back in through the hole they start to pink up and look as normal as the traumatized intestines can. As I look around I find that there are two places the small intestine has been torn in two and there is a section of transverse colon that is devitalized (dead) because the mesentery was ripped off it. So I take out the small part of intestine between the two torn pieces of small intestine and tie off the mesenteric vessels. Then I do a single layer hand sewn anastomosis. This is a series of small sutures about 1mm apart that reconnect the intestine back together all the way around the opening. After about 45 minutes Im done with this one and work on the large piece of intestine that is devitalized. I cut out the dead piece then re-anastomos it the same way. There is still bleeding coming from somewhere. So I feel up for the spleen- it’s lacerated too. I open the skin all the way up to the sternum. Now I can see the upper abdomen better and there is a cross shaped spleen laceration over the whole surface that is bleeding some. As I inspect further, I see there are two holes in the diaphragm. One laterally is about 10 cm and one right in the center of the left hemidiaphragm is about 2 cm. I stick my finger through and feel lung. So I get better exposure and suture up the diaphragm. The patient keeps moving because he is only getting Ketamine as his anesthetic as the anesthetist didn’t think his BP was tolerating the isoflurane inhalation anesthetic. So the patient would start tightening his abdomen like a sit-up and I’d have to ask him to give more. This took a while. After that I put a chest tube in to re-inflate the lung. Surgery had been going on about 5 hours now and I verified there wasn’t any additional bleeding. Again I washed out the whole abdomen with a lot of fluids. (The solution to pollution is dilution- so diluting out all the poop and bacteria in the abdomen ). I closed the fascia and then skin loosely. I went to the old OR to get one of the pleuravacs (container that attaches to chest tube) I just brought. I plugged it up and then started my paperwork as he was extubated and taken to the recovery room. About 5:30AM. I did my paperwork and did one of the most lengthy notes here. In case anyone else has to re-operate on him. As I go out to the recovery room, I see Phillipe bagging the patient. Oxygen saturation is in the 40%. He hasn’t called me to tell me there was a problem. How frustrating!!! So I take over bagging and the patient is posturing decerebrate. This is usually a sign of brain damage. Finally I think the Holy Spirit prompted me to give Valium. So we give that and the posturing stops and he relaxes. Slowly the oxygen level rises. If he wasn’t brain injured before I suspect he will be now. I pray for him and ask for Gods healing and command the devil to leave him alone, this is Gods hospital and we are Gods people. The devil has no right to harass him.
I stay for an hour, then decide to go back to the room while Phillipe stays at the bedside. I eat some breakfast of toast with PB and mango sauce. I shower then go back in. Phillipe has started an Epinephrine drip. As the day goes on I adjust that drip to try and keep his pressure up to the 80’s. I go through my day of operations checking on him between cases. I also see come of the consultations. At about 4:30 Im crashing hard. So I’ve finished the last surgery and go back to my room to drink a cold electrolyte drink and then go to Meghans house with Zach to eat. I go home and lay on the floor in front of the fan- and I’m out. I awake after 3 hours having missed calls from Dr. Andrew and texts.
I go in to check on the patient again and Dr. Andrew has been at the bedside for hours and they’ve set up and “ICU” with oxygen, a monitor and a norepinephrine drip. I relieve him so he can go home and sit at the bedside till 9PM when the night nurse comes on. I tell her about the drip (things they have never seen), and to leave the rate alone. As well as all the nursing students. Sure wish I had an expat ICU nurse with me tonight! But I know I’ve done all I can do for this man. And to be functional I need to sleep. I feel like I’m wound down enough to sleep again.
I’m not called all night so I sleep fairly well. I check on him at about 6AM when I awake and he has made it through the night.
God heal this man! Show Your power and love to him. Be glorified God by what you do in this hospital. Help us to recognize all that You are doing here. Give me wisdom and strength for today. Amen.
