Hernia’s are nothing new. I do them a little different here than in the US but the result is the same… No more bulging scrotum, No more incarcerated or strangulated bowel, less pain after healing.
I open the skin with the scalpel, control bleeding with electrocautery. Divide the external oblique fascia. Then search for the hernia sac. Today it was very large on the left and smaller on the right. I dissect it out from the rest of the testicular cord structures. I open it, then twisting it at the base tie it off. I place a piece of local mesh into the hole and place a patch of the same as a reinforcement. I tack it in place. As I start the left side I hear a commotion. I ask Ganava to go out and check what’s going on. He leaves, leaving Lauren to watch the patient and keep him asleep for me. I am scrubbed for the first time with Allison. She wants to learn but has no experience, it’s slow at the start. Ganava comes back and says there is a woman there with a child that is breech (buttocks presenting first) and she’s pushing. I ask them to call Audrey to evaluate the patient. She needs a C-section. I try to hurry. Audrey pokes her head into the operating room and asks me if I want her to close this patient or start the spinal on the woman that needs a C-section. Ganava rushs off to start an IV. I am able to finish quickly and decide to use one of my seldom used staplers, to close skin quickly. Ganava takes care of dressings and wheels the patient off to their room.
In the other room two feet are protruding from the vagina. She is prepped and sitting on the feet so I can do a spinal. I jokingly ask if the babies feet are OK with mother sitting on them. I ease the needle into her back, clear spinal fluid flows out. The spinal medication given I quickly lay her back and position the table. Audrey and I scrub quickly. Kalda preps and drapes the patient. I sweep across her abdomen with the blade and her skin lays open. The fascia is opened. The bladder held down and the uterus opened. Meconium (baby’s poop from distress) gushes out, blood is flowing. I struggle to get the babies feet up to the incision. Finally one releases after the other. I pull him down. The head is stuck. I twist and the head pops out. Thick, brown meconium sliming his face. I suction frantically before he takes his first breath. He takes a half breath. He’s blue and floppy. I suction, rub, tap and encourage him to breath. Praying that he hasn’t already blocked his airway with meconium. Finally he takes a big breath, then another. I rub some more. He starts to cry. I am relieved! I hand baby off to Kalda and continue working on the mother. The uterus is closed and finally stops bleeding. Sequential layers are closed as usual. Audrey and I are happy to have a live baby, and so is the mother, who starts having shaking chills. Her temperature at the start of surgery was 104”F. Our medication is finally working and it’s coming down. We start treatment for malaria and will check the malaria smear in the morning. We head home to rehydrate after a full day. Praise God for Life, Greg
Shanksteps #106