Chad 2022 #3
It was another full day of operating from 8AM till 9PM. Dr. Andrew has been doing this for weeks or months, and of course so have the other doctors here. No need to wonder why missionaries burn out! We have been running separate ORs all day and the list of waiting people doesn’t seem to be getting much smaller as people are added each day.
If you had difficulty urinating, how long would it take for you to seek help? I operated on a guy today that had had difficulty peeing for a long time. And since he has been on a long list waiting for his operation he has still been waiting. So today after about a month of waiting, I did his operation. I looked in his little book, and he had an ultrasound that showed a bladder stone. (Picture below) His operation went like this:
He got a spinal anesthetic, then he was prepped with betadine and the cloth drapes placed. My surgical gown had a huge hole under the armpit and along the arm so I asked that that one be repaired and took out a throw away one. (That must have come in a container from the US). it was thin and I wondered if it was even water proof- it wasn’t. I opened the low abdomen across above the pubis. Cut down between the rectus muscles and spread around the bladder with my fingers. I opened the bladder up and down with electrocautery to minimize the bleeding. I put my finger in and feel a large stone. I realized I hadn’t opened the bladder far enough to get the stone through the hole so i made it larger. I grabbed the stone and it was large! I felt and found another, then another then another. I could see where the smaller stone had rubbed on the larger stone. No wonder he had difficulty peeing! They can create a ball valve effect and block off the stream of urine.
Next was a postmenopausal lady that had vaginal bleeding. She had been evaluated with ultrasound and was found to have a large uterus tumor. She got a spinal anesthetic, we cleaned her abdomen with betadine and we started. She had had a previous ovarian cyst removed so I was able to use that incision which was vertical and along the midline. Then inside there was scar tissue to go through. I wasn’t to difficult and soon I was able to feel around for the uterus. It seemed to be stuck on one side but the other was mobile. I started on the mobile side and tried to free up small intestine and large intestine that were stuck to it. it was densely stuck and so i left it for the time being. On the stuck side I tried to figure out if it was removable or not. After freeing up some more adhesions, the cancer had grown into the pelvic side wall. Taking this out wouldn’t have extended her life and would have made her bleed a lot, and she could die that night. So i decided to stop her operation and leave the cancer in place. Here, surgery is the only option for cancer. There is no radiation or chemotherapy in the country. If someone has a lot of money, rare, then they could try to go to Yaounde in Cameroon and possibly get chemotherapy. So I closed up the different layers and took her to our recovery room. We called her son and nephew in to tell them the news. We asked them to translate to their mother. When I got to the part of the cancer not being removed, they didn’t translate. I asked why they didn’t translate. They said she will cry and may give up. They may tell her later. The students with me agreed that that was the best way. I doubt she will every know her diagnosis.
I did a hernia and a few other surgeries and was home to eat about 9pm. Dr. Andrew was there till after i left finishing up another surgery. Courageaux Andrew!
