Shanksteps #132

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Shanksteps # 132

I knew it was going to be a tough day.   We had just finished a C-section at 2:30AM.  Took a shower and headed to bed.  I drug myself out of bed at 6AM.  I made hot chocolate and had my own worship, arriving at the hospital at 7:30.  I had a colon cancer to resect today and was worried about it.  I had diagnosed it on colonoscopy back in February.  He was the head nurse of a health center and had decided to try traditional therapies.  Now after many months he came back to have it removed.  In Maroua (three hours away) they had asked him $400 to remove it.  Here I expected it would end up being about $200.  Money isn’t really an issue for him, but he chose to have it here anyway.
After morning worship and sign-out I headed to the office to see a few patients that were waiting there.  There was the follow-up for typhoid treatment, a bad pneumonia with significant shortness of breath, a child with a cough for months and weight loss- possibly TB.  There was a woman coming to follow up her hypertension, a teenager with a right inguinal hernia, and an old man with prostatitis.  Finally there were no more for the moment so I “ran away” from the office.  The office is kind of like the ER, if you are around their will always be one more question or one more patient to see.  Audrey was making rounds on the pediatric ward with 28 patients (24 beds, some two to a bed).  I made rounds on the maternity/surgical ward as usual.  There were three recovering from prostatectomies this past week, three who delivered a newborn over last night, the girl that we did the c-section on in the morning.  Others were wounds that were healing, a child with chronic constipation r
equiring rectal lavages, and the girl healing from her skin graft following a burn of 2 months ago.    There was the boy who caught his fingers in the grinding mill, taking care of half of three of them, requiring a revision of the damage.  There were two with endometritis after delivery at home and two with threatened abortions after working all day in the fields; another with gonorrhea PID who is pregnant.  Finally we were ready to start the colon resection.
He was a large, short man.  Unusual for most surgeries here, he had a number of inches of fat to go through before reaching the inside of the abdomen.  Intestines and omentum spilled out as he tensed his abdomen.  Ketamine (anesthetic), love it and hate it!  It was taking a lot to keep him from moving.  He did tell me ahead of time that he drank SOME!  After exploring all over I did not see evidence of any metastasis. The tumor was low in his pelvis.  I identified the path of each ureter.  Mobilizing the descending colon, we ensured that there was adequate length to reach the lower portion once we had resected the tumor.  After removing it, how would we put it back together?  Normally I do a hand-sewn anastomosis between the two pieces of bowel.  This was really to low.  I thought we had one circular 29cm rectal stapler.  So it was found. I hadn’t used that style before but was able to create a good anastomosis.  Filling the abdomen with saline (to look for air bubbles – l
ike looking for leaks in a tire tube) the anastomosis proved airtight.  Four hours later we were done.  (seems so easy here, one paragraph!)
I dropped my operating stuff off in my office.  Saw a few patients that were waiting for me.  Amadou called me to see a patient in the ER.  It was the son of the Sous-Prefets assistant.  He had been by the road and hit by a passing motorcycle.  He was conscious and had a wound on his right head behind his ear.  Grey tissue was in the wound.  Oh this looked reminiscent of a few months ago.  I put on gloves and examined him.  Some scrapes and bruises were found on his legs.  His head had a depression that my finger could sink into.  Pupils were reactive.  He needed to have his open skull fracture debrided and closed.  I called Jacques to come give anesthesia and ran home for my first meal of the day, it was 6:30 PM.  I inhaled some potato fries and salad and went back.
After putting him to sleep, I opened up the area on his head.  The skull had been punctured and many fragments bent into the center of the hole, grey and white brain tissue pooled in the area.  With difficulty I removed or elevated 7 pieces of bone.  During the process one artery was uncovered that bled profusely.  After a struggle I was able to tie it off adequately.   I could not find enough dura to close.  I created a patch out of temporalis fascia and sewed it in place.  Placing a drain, I closed the hole.  His pupils were reactive and we sent him back to his room to wake up.
“Doc, can you see this woman in maternity?”  It was Amadou again.  A woman was in labor at home since early this morning.  She had been “worked on” and had a very edematous perineum.  The baby had sounded good to him.  Oxytocin had been started to restart labor.  Now she was having abdominal pain.  Examining her, there seemed to be enough space for the baby to come out, but I found no baby heart beat.   I ran to get the ultrasound.  Baby was head down and the heart was not moving.  I thought I could see the placenta laterally but wasn’t sure.   I attached forceps and tried to help the fetus come down.  It seemed unsuccessful.  Then I realized that she had ruptured her uterus.  So back to the OR we went.  After 30 minutes we were deciding whether to repair the uterus or was it too damaged.  She had told me she didn’t want more children.  It was fortunate because it was very damaged and we needed to remove it.
Yaouke came in and mentioned that we needed to see another kid when we were done. She had eaten a meat sauce with a bone in it and felt it get stuck in her throat.  She had a lot of salivation and couldn’t swallow.   We finished up the operation.  It was 2AM.  We pulled in the girl to the other OR.  After writing my operation note, I went and did a laryngoscopy.  I could not see anything unusual.  I prayed that she would not have any real problems.
I arrived home, showered and fell into bed.  It had been a long two days.  God give me the strength to continue.  Give me patience even though I feel very short tempered.

Counting on HIM, Greg

#131 Shanksteps (of faith)

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#131 Shanksteps (of faith)

I was in the shower when I heard someone crying.  I knew that Greg was on the phone with his family so I thought that probably he was instead laughing hysterically. When got out of the shower, I realized that it was true crying; not the kind of wailing that the women do to announce to the village that someone has died, but true, honest, heart wrenching bawling. When I walked into our living room, I was met with a peculiar site. Greg was sitting on the floor with his arm around our nurse Mbaitomo. The nurse’s wife was sitting next to them. Mbaitomo was pouring out his heart to Greg. Mbai is the kind of guy that always wanted a son to carry on the family line.  However hard he tried though, he ended up with 8 girls. Two days ago he found out that one of his youngest was pregnant, and took some kind of traditional concoction to abort the baby.  He found out because she was bleeding all over their house.  After consoling Mbai and his wife, Ruth, we told them to bring the girl in
so we could check on her.  Sure enough, she was pregnant; but not just one or two months like I assumed; not even four months like she claimed; but the baby was almost 7 months along; and now dead (confirmed by ultrasound). To make matters worse, she had already ruptured her sac of amniotic fluid, and the baby was transverse (sideways). This meant that we wouldn’t be able to turn him so he could come out head-first (or even feet first).  What it really meant that this baby wasn’t coming out at all except by Cesarean section.  This was not what Mbai and his wife wanted for their 15 year old (unmarried) daughter.

So, Greg and I took her to surgery.  She weighed about 80 pounds, with a protuberant belly. She had a fever of about 104  F.  The surgery was like any other C-section (with a stillborn) except that we were now doing it on a friend. Fortunately God blessed and we were able to remove the dead fetus without too much difficulty.  We finished at 2:30 am and went home to bed – very sad that her bad choices had to turn out like this.  She is starting to heal but still very sick from an infected uterus. Please pray for her physical, emotional, and spiritual healing. Pray that she will be able to have children in the future. Please pray also for forgiveness from her family.
In His grip, Audrey

#130 Shanksteps (Shanks steps of Faith)

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#130 Shanksteps (Shanks steps of Faith)

Today was Sabbath.  I was able to “sleep in” till 6:30 when they called.  Actually I woke up at 6.  My body used to one time won’t let me really sleep in.  I go in to see Nafissa.  The woman who I talked about in #128.  I had seen her during the night when she went unconscious after getting up to use the bathroom.  I found out she was hypoglycemic with a glucose of 16 (normal >70)  Now I find her conscious but breathing very rapidly and seemed to be doing worse.  Her bleeding had stopped a few days ago, her nasal bleeding also.  There was no more diarrhea.  She was still anemic and had received 1.5 liters of blood since she came to the hospital, I believe a record for someone here.  All three family members that were here, were willing to give.  Her lungs sounded like she had pulmonary edema, her body puffy, as it has been for the past few days.  The nurse had put her on oxygen until the power went out again.  It flickered back on, so we restarted it.  She was breathing bett
er with it.  The nurse gave her medications and I went off to see other patients.
There was a question about a child with a hematocrit of 10% who they were not finding blood for and was unconscious, a woman who had a seizure at home and was now combative, and a 2 year old that had just arrived with anemia and a fever of 105.5  These were the beginning.   I saw them and headed home for a bite to eat and planned on going to church.
After preparing, I left to go to church, only to be stopped by the guard, Allah-Hokki, telling me that they needed me at the hospital again.
I placed my Bible on the ER table and started examining a woman with severe epigastric pain.  I saw a few on the wards that the nurse had questions about and did a lumbar puncture for meningitis on a 2 year old.  I walked back to church just as everyone was leaving.
The afternoon I admitted a couple more.  About 4PM I decided to go for a motorcycle ride.  Audrey had a migraine so she stayed at home.
I ride out of the village.  All is green as it is the rainy season.  Millet stalks 9 feet high sway in the breeze.  Bugs hit me in the face.  Large cumulus clouds hang in the sky.  I ride past three little boys, each pushing a bicycle tire with a stick.  Little kids are sitting in the dirt pouring it on their legs.  Mangy dogs, with flees and ribs showing, give me a sideways glance as they make sure they are out of the way.  Men sit in groups under trees playing cards or speaking the latest gossip.  I pass some women carrying wood on their heads, headed for home.  Near the government protected forest, I see little thatch roofed shelters along the road with boys, a man, or woman sitting outside them.  I stop beside one to ask why they sit there where no one is and where there is no village.  The boys tell me that they are protecting their crops, across the road, from the baboons.  They say the baboons especially like corn.  I go on up through a shallow river bed and on to the
mountain with red dirt.  I figure I have been gone long enough and need to get back to see if the hospital needs me.  I am refreshed once again.  I ride back past all the same things.  Many people are in the same places.  Life is slow and purposeful.
I stop my motorcycle outside the “urgence’ (ER) and immediately I hear wailing.  It is coming from maternity.  Nafissa!  I cringe and walk to inside.  Jonas confirms it was her.  Also another 10 year old boy we had been treating for an arm infection, who has been getting better for the past week; went out side to use the latrine and he died as he walked.  Crying could be heard from the adult ward as the woman with seizures and meningitis died.  I go back to see the man who was breathing hard and we had put on oxygen.  The power had just been cut off again for the third time today and he was breathing his last.  No time to get my little generator out for the oxygen machine.  Four deaths within an hour.  We have sensed a spirit of death here before, and have had much prayer asking God to remove it.  We ask God to guard the physical and spiritual entrances to the hospital with His guardian angels.  Please pray with us that the devils power at the hospital be overthrown by Gods
power, and that whatever is allowing the devil freedom to work here be made null.  Pray that my life and in the workers lives are put in harmony with Gods will that His power can be manifest through us and that we reflect His love to these people.  We appreciate your prayers and letters.  In His Service, Greg

Shanksteps #129

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Shanksteps #129

She was there when I arrived at the hospital. She was about 18, lying on her side on her bed. Gaunt eyes looked up at me. I approached and asked how she was doing. She said OK, but almost inaudible. I saw a small piece of gauze hanging from her left nostril. It looked like dried, maroon colored blood. Her abdomen protruded with a gravid uterus. She was 7months pregnant. She had come into the hospital with a hematocrit of 10%. Her husband had already given her 250ml of blood and her mother also 250ml. Her repeat hematocrit was 16%. Her husband again gave 500ml of blood. She had developed epistaxis again overnight and had had her nose repacked by the nurse. I checked her conjunctiva and she was very pale. She noted that whenever she sat up she got very dizzy. Her BP was 110/60 and her pulse 136. She needed more blood. As I examined her she was having abdominal pain. I checked her abdomen and found a very firm uterus. The nurse had not tried to get a fetal he
art rate, so we searched for it, but found none. She was having contractions. I asked them to try to find more blood as I continued rounds. After only a couple patients her mother came to get us. She thought she was delivering. The nurse ran to get gloves while I finished with a patient. As I go back to her room I find a still born lying on a small white sheet. Jacques is massaging her uterus, she is bleeding vaginally now, as one would expect. Running to the lab I encounter her one other family member who was being checked out. She did not match. Kanas didn’t want to take my blood as I gave a little yesterday. I sit in the chair. My left arm is swabbed with alcohol. A LARGE 12G needle is inserted into my bulging anticubital fossa. “Red life” flows from me into the bag on the floor. Soon it is bulging with 500ml of blood. I run back to maternity. It seems the bleeding has slowed.
I continue my rounds. After seeing about 6 outpatients, Jacques comes into my office, “Doc, she is still bleeding!” I hurry the patient in front of me out of the room and run to the delivery room with my headlamp in hand. Pools of clotted blood surround her buttocks. I perform curettage and remove some pieces of retained placenta. The bleeding subsides. Her BP is 90/40 and her pulse 145. There is no one else able or willing to give blood. Fluid slowly brings down her pulse.
I am called to see her again. She is having copious, watery, diarrhea. She is very thirsty. We pour in more fluids. Her husband looks concerned. He is happy that her bleeding has stopped but is still worried if she will do all right. I am concerned too. God made us incredibly resistant, but at some point it becomes “to much!” There is no power for two days now. The water has just run out of the tank. We make sure each nurse has batteries in their flashlight and we head home for bed. We have just heard that tomorrow our order of medications is arriving from the south; we must go to Maroua to pick them up. I am thankful to have friends at Meskine Hospital where they will arrive. I call them and they agree to keep them a few days for us. I can operate as planned on the old woman with a partial bowel obstruction and do the circumcision on the 18 year old I saw today in clinic.
God, give me peace and rest for tonight.

In His Service, Greg