words that should never have to be spoken in the O.R… particularly during a routine minor procedure. then again, what we consider a minor procedure in the states can quickly turn into something major and complicated here, as we saw today when the doc attempted to remove a small lipoma from the back of a young maasai man.
this procedure was interesting to watch for several reasons: 1. the lignocaine was given using, I’ll say, an interesting technique. 2. the initial incision was massive, aka unnecessarily large, aka absurd by u.s. standards! 3. there was a point during the removal when the doc said ‘it looks like lung tissue’ though they were superficial to the rib cage… excuse me? 4. there was massive blood loss for a procedure that should have been very minor and no one seemed very concerned. and then, oh that’s right, 5. the patient started falling off the table mid-procedure and I had to be the one to point it out, though this poor maasai boy was surrounded by docs, nurses and medical students. what’s worse is that the reason he was falling off the table is because he was writhing uncomfortably in relative pain during the procedure. guess that interesting technique for giving the lignocaine wasn’t all that effective…
other reasons the O.R. here often makes us cringe… the first procedure of the day was supposed to be a plastics case. oddly enough it was on dr. lee’s schedule as he is probably the doc at mt. meru hospital most qualified to do this scar revision. when you have an ortho surgeon doing the plastics cases you have to ask yourself if… actually never mind, you get the idea, this shouldn’t be happening. point is the patient is on the table this morning and one of the local docs comes in and begins discussing other options for reducing the scar. aren’t alternatives to surgery supposed to be discussed before the patient is actually on the table prepped for surgery?! silly me, that’s apparently far too reasonable. this poor patient was lying there as the one surgeon was saying ‘maybe steroid can make this better’ and dr. lee was saying ‘non-surgery option is best, please try other options, I don’t know plastic surgery well but I could make this better if she needs surgery’ – ultimately they decided to try steroid injections for two weeks before resorting to surgery. go mt meru, we’re making good decisions on occasion at least! (even if it is done is a roundabout and time-inefficient manner).
next we’ve got a few knarley time filler cases – mostly leg injuries from motor vehicle crashes, and some crazy open wounds!! there was also a tiny boy with a badly broken arm. when they went to knock him out I jumped in, eager to help, and turned his head away from the injection and tried to distract him. he was so stinkin’ cute and I comforted him until he was out. the kids here are too much, ridiculously adorable (and unlike the maasai children they aren’t absolutely terrified of mzungus). kurt and I always joke about distracting the parents and taking the kids away :) instead we make them paper airplanes and give them pens (awesome, right? not really, but they’re usually pleased). as much as I love kids, I cannot stand seeing them in pain – no thanks to peds for me. it’s easy to know how to interact with kids (too many years as a nanny, and I did two rotations in peds last year), but I can’t handle watching them suffer. and you should have seen the way they manipulated this arm before casting it (very different than what we think of as a cast in the states, by the way, they call it plaster of paris – POP – and it looks like a second grade art project when they finish)…I was certain they were going to dislocate his tiny shoulder in the process the way they were yanking on his forarm and putting counter traction on his rib cage – spells disaster. hope the poor kid’s ok, he’s definitely going to wake up with a very sore arm.
next on the schedule we have two amputations. both are necessary because the patients have gangrene, both sound like they’re be above the ankle, one is on a 75 yo male, the other on a 100 yo female. what?! unfortunately (that sounds morbid, but you know what I mean), one of the patients backed out last minute and the other had a Hb that was too low to safely do the procedure. too bad, kurt was with us in the O.R. today and we were lookin’ to get him in on some wild procedures. there’s always thursday…
a few things I will miss about arusha:
-being able to walk everywhere (though I’ll be happy to be home in a place where I can walk around safety at night)
-having fruit stands everywhere that sell the most delicious fruits and veggies for ridiculously cheap (our favorite veggie stand lady today gave us green beans, a cucumber, two carrots, an eggplant and a zucchini all for the equivalent of 75 cents.)
-walking down the street past a guy with a bunch of sugar cane tied to his bicycle, giving him 200 tzs (about 15 cents) and having him cut off and skin a piece two feet long, then create chops in it so that it’s easy to bite, then just chewing on and sucking the amazing juice out of fresh sugar cane as an afternoon snack.
-not having to rush anywhere… ever.
something I really will not miss:
-people staring at you, greeting you, talking to you, wanting to shake your hand and know about you everywhere you go. I am sooo excited to be anonymous!! it’s going to be amazing to walk around and not stand out, to just be an average person able to blend in and to be ignored. I’m realizing I would make a terrible celebrity. who knew anonymity was such a luxury?!
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