Hello again from Malawi, second day:
After the late night last night, I still start at 7AM. After worship I started to make rounds with Siti. She is a clinical officer that has had three months of rotation on the surgical service. As we made rounds she had gloves ready, charts at the bedside, x-ray films set out by the appropriate patients… She was very organized compared to the person I rounded with yesterday. Like yesterday, the rounds were interrupted multiple times. Some to see patients in clinic and others to do a gastroscopy on a 14 year old Pakistani girl that had significant reflux in spite of treatment.
Next was the woman with a femeral head fracture for traction. I had asked the OR staff to sterilize the pin that is used to go through the tibia bone for the traction. It had not been sterilized. When questioning them as to why, they said that they don’t have enough packs to sterilize it. Apparently they wait a few days till there are a number of surgical packs ready to be sterilized, then they build a fire under something that produces steam that runs the autoclave to sterilize the equipment. The process takes a number of hours, so it was being done today. Tomorrow is a clinic day at an outside clinic, so it will have to wait to be added to the things I have planned for Thursday.
I was called to see an older gentleman who was found to have a urinary stricture after a prostatectomy and had a urine catheter in his lower abdomen. He wanted surgery to address this, and has tried each surgeon covering this hospital. Dilation has been tried here and elsewhere to no avail. So I assured him that if multiple surgeons have been unable to pass a dilator that I also would be unsuccessful and told him he would have to live with the cathater.
I was then called to see the lady who I had done the below knee amputation on yesterday. The nurse said she was breathing poorly. So I went up to see her. Her saturation had been 70-80% all night (normal >92%). She was breathing poorly and had wet sounding lungs. I ordered lasix, and headed to the OR for the other patient they were putting to sleep.
“Mike” was a 18 year old guy who had been in the hospital for 5 days with a dislocated elbow. His arm was hanging from his hand from the bed frame. The weight of his arm had NOT replaced it for days. I had seen him the night before, and decided that since his elbow had been out of so long waiting overnight to sedate him, wouldn’t hurt him anymore than the damage already done. So on the OR table he lay. Ketamine was given for sedation, then I started. I pulled and manipulated his elbow and finally heard a pop, it was in place. I moved it and realized it was out again. this happened a few times. then I decided to place a cast on his arm to help hold it in place.
I went to recheck on the woman who had an amputation and found a better oxygen level. I went back to Cristy’s house and had a nice evening with her and friends.