Bere 5/2025 #7
Always enjoy Friday evening worship to open the Sabbath.
Friday-
This day went rather quickly as it was quite busy. Andrew was doing a thyroid with a large goiter and I went to make rounds after morning worship. I saw all the same types of patients I’ve mentioned these past few days. The ones of interest were the man who was gored by a cow horn- he is doing better and is fully awake and communicating. Is having a fever and is drinking some water OK. Still waiting for his intestines to work. The other is the child with a Tylenol overdose who had meningomyelocele back surgery. Still having fevers and is being treated for meningitis. Rounds took about 1.2 hours.
I went into check how the thyroidectomy was doing and Andrew wanted me to scrub in with him. There was some weird anatomy that had made it real challenging. So I scrubbed and took over the place of his assistant. It was a tough, long, tedious surgery and we got out a 2 x 4in goiter.
The next one I had was a lady who had had a mouth mass that was growing a couple years. It grew off her gums and hung down in front of her teeth. It had outgrown it’s own blood supply so it was necrotic and smelled awful! I had asked Andrew to ask an ENT friend wether exposed maxilla would heal or not. We never got an answer. So I figured I’d take it off and hopefully I would be able to cover the bone with what was left. It is so sad that people have to live with things to get to this point. Terrible!! I’ll attach a photo at the bottom. I decided to start with a huge suture around the base because it seemed to have a smaller stalk at the teeth level then mushroomed from there. So I looped the suture around the stalk and tightened real tight. Then I cut off the majority of the tumor. Then I could see to do something more. She was already asleep with ketamine, but I injected some lidocaine for hemostasis. I made an incision in her upper gums and dissected down to the bone. Then I went across on top of the bone and beneath the vessels. Then I created a space between the gums and the vessels. Then I tied the vessels off higher and cut off more of the tumor. I then used a rongour to bite off pieces of maxilla till I have the feeling of good hard bone. My goal was to get all the cancer so it had a lesser chance of returning, though at this size I assume it has already gone into other lymph nodes. After biting off all I thought would have tumor in it, I mobilized the upper gums and was able to get closure over the maxilla. She went to the recovery room.
Then there was another miscarriage woman who was still bleeding and so I took her to remove the retained placental products. This went well and took about 10 minutes once her spinal had been placed. While I did that David took the burn girl in for debridement. When I was done with the D/C I went to help him. We each had scissors and were cutting off dead tissue of the woman who seized and fell in the fire. Some had started to suppurate and separate from the underlying live tissue. So we cut dead tissue away aggressively on all the spots that she had burns that were deep.
The last one I had of the day was an anal fistula. These occur after a rectal abscess and have persistent purulent drainage from a little hole near the anus. Annoying to always have some moist pus sitting there. The solution is to cut the tract open. So after a spinal, I stuck a metal probe into the tract. I slowly felt around with the probe till I found the entry into the colon. I flayed open the tract till where I could feel the anal muscle. This I put a stitch through the trap and tied it on the outside. It will slowly work it’s way through the muscle, healing the muscle behind itself. This way there is minimal risk of incontinence.
I go home and get my laundry off the line that one of the ladies were paid to wash today. Then on to eat supper at Megans house then to the Sabbath start worship. We sand some English hymns a French hymn and some Childrens songs. Then discussed a passage of scripture in 2Kings. I’m enjoying the community of missionaries. For the most part we are quite up front with each other, avoiding the superficialities. And I like the honesty.
I check on a few patients tonight and start my cow horn trauma guy on malaria treatment because he still has a fever.
God guide us in our treatment of patients. Most of all Lord, heal them with your power! You are the healer and we want Your healing for missionaries that are sick and for all our patients. Also use me in Your healing process if You want that. Amen
