inspirational quote for the day, you ready for this? I read this every morning on the hot water jug they put out for tea. It is baby pink and has a hideous flower design on it. in small print at the bottom it says: “there are no springs without flowers, there are not gains without pains” – inspirational, right? yeah, they know how to start the morning off right here :)
today we left for the hospital tres excited because we had seen many a sweet case in need of operations yesterday, and today the OR schedule was packed!! thu and I raced to change for OR time while amy went to peds, intent on meeting up with us later. we dropped off some supplies with the OR nurses and got the same excessive gratitude we always get. It doesn’t matter if we’re giving gloves or masks or scalpels, you’d think we’re saints brining in these supplies, and we usually get blessed by the staff in one way or another. So all of you out there who donated to this trip, thank you, because your donations are making a big difference to the people here, the hospital staff and patients alike.
we were in the major theater with dr. lee today (minor theater was mostly for more casting). we were scrubbed and ready before all of the docs so we chatted with the engineers a while. not sure if I’ve mentioned them yet but we met them during our second week, two boys part way through their undergrad who have come here to fix pretty much anything and everything. no joke, they’ve fixed everything from cribs in the nicu to the xray machine. pretty handy guys I guess, the great news is they just got the bovi working! very exciting to have a tool that actually cauterizes arteries rather than having to tie each bleeding artery off individually (unfortunately the voltage is still a little off so it didn’t perform as well as we were hoping during the surgeries today).
the first patient was a young boy we had seen yesterday. the lateral condyle of his humerous is protruding, not through the skin, but it’s an obvious break that had caused a fixed bend in his elbow that will lead to serious problems as he grows, so dr. lee is doing external fixation today to try to repair it. the surgery is so interesting, partly because I love the skeletal system, but also because of the way they do things here. surgeons back home would cringe at the disorganization. surgical instruments sprawled across the “sterile” field, nothing that dr. lee needs and a lot of stuff just getting in the way. the lighting is terrible, I suppose we’re lucky to have electricity on this day and shouldn’t complain. dr. lee has taped the boy’s xray to the window across from where he works, to reference during the surgery. all goes well, aside from the attempt to knock the poor kid out for the surgery. they try to intubate, but the boy is awake enough to cough out the tube, not good. they give him more drugs, he’s on a ventilator but breathing on his own so it’s not on. the “anesthesiologist” is manually bagging periodically but I can’t help thinking this kid is not getting enough oxygen to his brain, and the brain does not tolerate hypoxia well. As the surgery begins the child stirs… more than stirs, he’s awake… is he crying? we’re all looking around, wondering what the plan is, will someone please knock this kid out?! finally they get it under control. part of the problem is that they have to make a decision when they’re putting a patient under, they don’t have the machines to properly monitor the patient so they must carefully find the correct balance between pain, and a patient that won’t wake up at the end of the procedure. it is a fine line and they tend to err on the side of pain, because the other way you have a drug overdose that leads to death. they finish the surgery, wake him up… sort of, he struggles to breath for a while but should be fine. it is all a bit stressful, more stressful than the ORs back home because if something goes wrong we do not have the same resources to fix the problem.
next cool surgery, motor vehicle crash… this one might have been a motorbike, or peds vs auto, either way, no good for the patient. The head of his femur is posteriorly dislocated and the acetabulum itself is fractured, along with the anterior part of the pelvis. that is bad in and of itself, but on top of that he has a severe ankle injury and a break straight through his femur. it’s actually quite beautiful, very straight and clean and I cannot even imagine the sound it must’ve made when it broke because this guy is young and fit and very tall. “that is a big femur” said one of the nurses who walked in the room mid-surgery. dr. lee is awesome. Makes the incision, finds the facial plane, dissects down looking for a plane between two muscles where he can find the fractured ends of the bone. they use a rod, driveit down the shaft of the femur to hold the two ends together. the surgery is long but time flies by, this operating theater is big and we have freedom to move around and watch from different angles. The patient is awake. Oh, did I fail to mention that earlier? Yes, this patient is awake, just numb from the waist down. He can feel his entire body jerk around as they manipulate the bone, trying to get it back into alignment. He can hear and feel the bang of the hammer against the metal rod they’re driving down his bone. he knows daaimah (who has joined us in the OR today to observe as a favor from dr. lee) is taking pictures and he keeps asking her if he can see them. We advise her to wait until after the surgery is over. It is amazing to me that a gumby leg, the thigh bending unnaturally as if there is no bone inside at all, can be fixed and looking almost good as new after a few hours in the OR. that is the magic or surgery :)
nothing works up an appetite like a few hours in the OR, and we had our best meal yet today, post-surgery… except that I think I’ve said that before, but it’s ok to think every meal is your best meal so whatevs :) we ate at a place called milk and honey. it’s a local spot that also caters to travelers, which is nice. I went with vegetable curry with chipati and I was so content by the end of that meal. I’m gonna miss chipati when I get home, I can already tell. It’s like the roti of Tanzania (yes lo, you heard me, you would love it!) and I think they need to start making dessert chipati with butter and cinnamon sugar like tanzania’s version of the elephant ear. I think I’ll tell a local this idea, get it started, and they’ll have the most popular chiapti stand in town. where’s rogers when you need him? he’d be all for it :)
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