So I thought I would tell you about my last 24 hours. For me it was rather epic. I did a lot of things I had never done before on my own. In fact as I think about it, the only two things I did over the last 24 hours that I am used to doing on my own were eating and using the bathroom.
Friday started a little late because I had been up coughing most of the night so I skipped morning worship. When I finally caught up with James it was at his house where I found out that he had malaria and was not planning on coming into work. I was on my own. After picking my heart up off the floor, I smiled, lied (I said something like, “Not a problem”) and headed off to the hospital, where two hysterectomies and God only knew what else awaited me.
My first order of business was to extubate the teenager who had had a grapefruit sized goiter removed the day before. First big mistake of the day. (I will try to post gross pictures on a separate page, so those who have a morbid curiosity can look at them, while protecting those of you with sensitive constitutions.) In my defense he was awake and breathing on his own, with a good saturation. And after a rocky few minutes he settled down and seemed to be doing OK. So I started in on arranging the day, and getting some rounds done. The first hysterectomy patient was on the table and had just had the spinal placed. I was sitting in the office reading about hysterectomies (this was my first solo) when I heard strange disturbing noises coming from the direction of my thyroid patient. You know, the noises of someone who is having airway difficulties. Sure enough, oxygen saturation was dropping, grunting respirations, the whole 9 yards. We tried bagging, and got his saturation up to 88% (should be 99%). It was soon clear I needed to reintubate him. I am happy to report that after 2 years (reality was probably 30 or 40 minutes, but it seemed like 2 years) I finally got the tube back in. That was after James came over and found the stylet that had fallen behind the autoclave.
By now my hysterectomy patient had used up half or more of her spinal anesthesia time, which meant we would be using ketamine and diazepam, and the relaxation of the spinal would be gone about the time I really needed it. So here goes my first solo hysterectomy, on a lady with a really big (for me) fibroid. The whole case I was praying and stressing about the ureters, the bladder, the bleeding, you name it, but Abel and I got it out. Although I think the blood loss was a bit excessive. A word about Abel, he is in charge of the OR, and the first assist. He is really good, very much like Andy Schug, (but not as good as Andy), but he has one tiny drawback. He is deaf. Now he reads lips really well, but during surgery that poses a problem. Luckily the handsignals for instruments are universal, so it works. Abel is also a bit impatient so when he thinks it is time to cut that uterus out, he lets me know.
So one hyster down, one to go, after lunch. Eating I could do. The second hysterectomy was for bleeding, and she probably has endometrial cancer, but no obvious mets, and the uterus was not too large. It went much better, especially with Ronnalee as second assist and Bekki as circulator.
Oh yea, between the two I had a four year old with a piece of jewelry in his ear, next to the ear drum. Then a guy who needed a window cut in his cast for dressing changes. Last time I used a cast cutter I burned Jonathan because it was dull. After a few consults a patient who had had an accident a week ago came in, he is now a quad. He had been at several hospitals before ours, and no one could get a foley catheter in his bladder, so he had a small IV catheter sticking out of his very swollen abdomen. The nurses were trying to cath him and there was blood everywhere. So off he went to the OR for a supra pubic tube. Earlier in the week I had used our only percutaneous kit and had foolishly thrown it away after using it. Silly me, disposable means you use it until it disintegrates into the orginal molecular form.Then there was the little girl with an open tib-fib fracture. She was last for the evening. Got her opened up, washed out, pulled out a chunk of free floating bone, straightened her leg, brought it out to length and then casted it. Last time I put on a cast was—Oh, lets see, 1987! As I headed out the door after 14 hours of work one of the nurses caught me. One of the consults of the day had stuck it out and not gone home. Oh well, it was a hernia consult, easy and straight forward. As I started to fill out the paperwork (Ha, you thought we didn’t have paperwork here, not true, just no computers) the patient says it has already been done, the paperwork, not the hernia. So sure enough we find the form all filled out and the hernia surgery paid for in advance (about $120 for the works). I then realize this poor guy has been waiting all day for his surgery, and it is now 8 pm. Everyone has gone home exhausted, so I had to tell him the earliest I could do his surgery was Tuesday. Imagine pulling that stunt at Valley Medical or St. Joes. These Tchadians are big dudes, I was glad he wasn’t mad at me.
Off to bed about 10 after winding down, but then the coughing started in again, so I finally took a sleeping pill, and blissfully headed off to dreamland, until 2 am. Tap tap on the door. OK I am coming. Hoping no one will notice my drugged state, I arrived at the hospital 30 seconds (literally) after leaving my room, and I was greeted by my thyroid patient in clear respiratory distress again. He had looked so good. So I suctioned him, could not get the catheter to pass, sats (oxygen saturation measures how much oxygen is in your blood) are now in the 70’s, he was awake and looking at me, pleading for help with his eyes. His guardian angel (I believe, because I am not that smart) whispered to me that his tube was blocked, so I pulled it out, and sure enough, there was a nasty clot in the end. We got a mask on him and praise God he settled down, sats back up into the high 90’s. Back to bed with orders to Appo the nurse to call me if he has further problems.
Slept till 4:30, woke up first to the call to prayer, good thing for Sabbath morning, then tap-tap. Appo was back. “Docteur, no power”. The oxygen concentrator had run the batteries dead, and the state electricity was off as usual. Fortunately I had written down the instructions for the generator. So off to the generator and get it started and get power back to us and the hospital. Back to bed.
Tap-tap, now it is 6 am. “Docteur, l’enfant est malade” (the child is ill, (aren’t they all?)), so I make the long 30 second trek to the hospital. They have taken the oxygen off the thyroid patient and put it on a little baby who has malaria and pneumonia. We only have one oxygen concentrator, but fortunately by now my thyroid guy is doing great, sats 95% on room air. Little baby, not so well. Grunting respirations, saturations of 60% and already on quinine and most of the antibiotics we have. Not much else we can do. The nurses suction him, and over the course of a few hours he improves, but still has a very grave prognosis. Too sick, with not enough resources. Shortly after that another little baby is brought over that we have been treating for malaria and meningitis. Now I am no expert, but if this kid does not have nuchal rigidity (a stiff neck), then they need to rename it. So I added another antibiotic to his polypharmacy (no tests, so we treat shotgun style, from the hip, and hope one of them covers it), and had the nurses give more diazepam (valium) to relax him. Also not a good prognosis. As I left the building I found his mother sitting on the ground with her head in her hands. I had explained to her that things did not look good. My French is not good enough to be abstract so all I could do was gently rub her back and shoulders, and hope she understood that I cared, and I shared her pain.
Then we made lightening Sabbath rounds, and I told the nurses that I was not available except for life and death emergencies, and it was Sabbath and I needed to rest or I would be sick as well. They understood, although they did come later and get me because they were out of gloves and I had the key to the container. I agreed that was a true emergency.
And so passed my first day really on my own. I know that all those who are serving or have served in these African hospitals are thinking, “Yea, and your point is?”, because this is everyday here. But your first is always unique and worth remembering, and someday I can read this again, and I will say, “Your point was?”.
Truth is my point is this. I understand a little better Paul’s counsel to pray without ceasing. I spent the entire day breathing a very brief prayer “God help me”, and there was nothing sacrilegious about it. It was heartfelt. We always pray together before each operation, and let me tell you, those prayers yesterday meant the world to me. And He answered those prayers in spades, I don’t think I bagged any ureters, or created any fistulas, I got the foreign body out, I learned a lot, and although there are some I can’t save, I didn’t kill anyone. All in all it was a good day.
For those of you new to our blog please look around at the other pages, the “About” page tells a bit of who we are and our background, the “Definitions” page explains some terms that are used that some of you may not be familiar with, such as GC or AHI. The “Timeline” gives an idea of where we will be throughout the year, and the “Video” page has a video Bekki made of Koza Hospital, where we initially were to be. Soon there will be a new video about Moundou. You will also find links to other missionary blogs such as Olen and Danae Netteburg, Jaime and Tammy Parker and others. Finally, if you like our blog and want to receive each new post directly to your e-mail, please sign up with your e-mail in the subscribe box. It doesn’t cost anything, there is no commitment, it just makes it easier to follow us.
ps. The kid with the huge goiter is doing well, the baby with meningitis is still alive but still critical, the baby with pneumonia and malaria died sometime on Sabbath, the little girl with the broken leg is gone, apparently the family took her home on Sabbath sometime. They will probably go to a local healer and get the cast removed and splint her leg with sticks and rags. The hysterectomy ladies should go home tomorrow or Tuesday. Thanks for your prayers, they make a difference without a doubt. sg