Tuesday, March 15, 2011

Monday March 14

Monday March 14

Jenn had to take the day off today as she has developed rather severe Tubman's revenge. We went in thinking that we would have a couple of small cases to do, but as often happens that was not the case. We found several emergencies to keep ourselves busy for most of the day.

First Yuk did a hypospadius repair with Konneh, and while she was doing that, Santiago, Eric, and I went to the ER to see a couple of patients. One was a man with a large scrotal mass, and the other was a man with peritonitis who was guarding and tympanitic, and looked like he was either obstructed or perforated or both. Then we had a call from Jenn saying that she had received a call from the mother who had shown up at the Guest House yesterday with her 3 year old son Santa saying that now they were at the ED. So we went in search of them, and found her and the 2 kids, one strapped to her back, and all of her worldly possessions in a blue plastic bag she was carrying on her head.

I should back up a day. When Santiago, Adamah, and I came back from our visit to JFK with the President, we found a woman with 2 young children sitting in the carport with a policeman standing next to her and the two psychiatrists also staying in the Guest House sitting nearby talking to her. The story was that she was from Nimba County; she is Muslim and had married a Christian who died in a car accident 7 months ago; as a result of the marriage she was ostracized from her family, and had no means of support; and her 3 year old son had a large communicating hydrocele. The policeman had taken pity on her, and had brought her to the Guest House because he knew that Adamah was in town and that HEARTT could possibly take care of her. So anyway, after much discussion, we said that we would take care of her, and that she should come to the hospital in the morning. In fact, Jenn asked her to come at 9:30 AM, but Adamah pointed out that she is illiterate, and actually had no concept of what 9:30 meant.

Anyway, she showed up, and had actually remembered to keep Santa NPO, so there was a good chance we could do his surgery today, if we could get through the necessary hoops. Fortunately we ran into Mary, the Clinical Coordinator, who took charge and made sure that it was all done expeditiously.

We went back up to the OR to learn that the next case was another emergency, but this one had been admitted yesterday with a strangulated right inguinal hernia. Why his surgery wasn't done yesterday by Dr. Muvu remains a mystery. Anyway, he is 33 years old and had a huge recurrent hernia. Yuk and I started the case under spinal, but found on opening the sac that his right colon was in it and dead. We converted to a laparotomy, and after some urging by me, anesthesia converted him to general anesthesia. On opening his abdomen, we found more dead bowel, but some still alive, so I asked Santiago to scrub in. We ended up resecting about half of his small bowel, and his right colon up to mid-transverse colon. At one point I saw his blood pressure was 50, and I was pretty convinced he was not going to survive. We removed his dead bowel quite expeditiously, and also his dead right testicle, and gave him an ileostomy.

After that we learned that the man with the acute abdomen in the ED had expired; I thought he was sick, but I was surprised at the speed of his demise. Moses went to see the man with the scrotal mass, and said that it was filariasis (elephantiasis) and did not require surgery. So Yuk and I did the 3 year old next, and that was uneventful, while Moses and Santiago did an incarcerated umbilical hernia next door.

On post-op rounds, we saw the man with the strangulated hernia and now with an ileostomy. He looked remarkably good for what he had been through. I explained that we had to remove half of his intestines, and that he had a temporary ileostomy which could be reversed in a couple of months. He held out his hand to shake mine, and said "thank you" in a very heartfelt way. As Santiago said, he knew he had been close to death, and he appreciated that his life had been saved; it was quite a memorable moment.

We came back to the Guest House to find Jenn in about the same condition; she said that the staff, especially Catherine and Welke, had been checking on her during the day. Having collected the necessary supplies from the hospital, we then did a little home surgery in the kitchen to remove a 3 cm lipoma from Catherine's upper arm; while conditions were somewhat primitive, the surgery was successful !

Santiago, Catherine the psychiatry resident, and I then went for dinner at Cafe Jamal with Yuk, Melissa, Robyn, and Guy, a visiting medical student from Oxford. We had an interesting conversation on a number of topics, and then back here for bed.

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