Liberia #7 After a short nights sleep I woke up at 7AM to my alarm. I knew that things started at 8AM. I knew we had many surgeries to do. I made some muslix that a friend sent with me, and went to the hospital. There we stood around the nurses station and had a short worship thought and singing. After that the nurse on overnight mentioned how many admissions there were during the night, 8 in all. And then I sterted rounds in one area and dr. Seton in another. After rounds she went to the OR to start a hernia surgery. Then I found out a lady had come in with fetal distress so she was doing a C-section instead. I initially went to the outpatient department in a tent in front of the hospital. But no one was ready yet so I went to see how the C-section was going, Id rather be in the operating room anyway. The baby came out while I was there and was blue and no cry. You may think, how can a black baby look blue? It’s in the lips, palms and soles of the feet! Heart rate was 40, we took the baby up to the head of the bed where there was oxygen for the anesthesia and stole it from the mom to use on the baby. After giving some intracardiac adrenaline and then some more subcutaneous, his heart rate finally picked up. With oxygen, he eventually started breathing and having pink lips, and started to cry.. Another woman in labor arrived, who was on her second pregnancy- 27 years after her last delivery! Wow, starting over! She was not leaking any amniotic fluid, though she said she had a few days prior. I started her on antibiotics and had the midwife assess her fetal heart tones and cervix dilation. The babies head was high and cervix still barely open.
I then went to the out patient department (OPD). I gowned up with PPE and went out so see patients. They would come into my “office”, which was a tent with a fabric divider and a table with a couple chairs and gurney. I evaluated each patient and ordered labwork. They would eventually get the results- usually hours later, and then see me again for treatment.
I was called to see a patient in a car that just pulled up. He had a headache, body pain and pale eyes. No vomiting, diarrhea, and no contacts with anyone sick or dead. So I admitted him for evaluation for malaria and typhoid.
Next there was another woman in a taxi that pulled up. As I was finishing up the patient I was seeing in OPD, they started wailing. I went out, and found a cool, still 65 year old woman. As the other women around shrieked and wailed, I said she was dead and they could leave.
Another car came, this 55 year old woman had fever, vomiting, diarrhea, body pains. Eyes were normal, but I was suspicious. So I doffed my PPE then went to ask Gillian her opinion. She was in the operating room doing the hernia repair. She said sent them on to an ETU. They are now treating for malaria and typhoid, so either way they’d be evaluated and treated.
I donned a new set of PPE, and went back to seeing patients. After each patient I would wash my gloves and stuff with the chlorine water, even though none of them seemed suspicious.
After seeing a variety of things: young woman with vaginal discharge and likely sexually transmitted disease, a thinning middle age man I diagnosed with HIV, a 13 year old girl with typhoid, another man with typhoid, a urinary tract infection…about 15 patients in all. It was time to do the prostatectomy.
The spinal was put in by the anesthetist, it took a while and I saw a fair amount of blood- guess he wasn’t hitting the right spot. I offered to help- he didn’t respond, likely offended but didn’t act like it afterward. The patient lay on the table. I prepped his abdomen with betadine, then put on drapes. One of the drapes was moldy and so we threw it away. I cut through the skin down to the rectus muscle (six pack in some people- unlike me). Then opening down to the distended bladder. Opening the bladder we suctioned about 2 liters fo fluid out. They tried multiple times to get a foley catheter in yesterday, unsuccessfully. So likely false tracts had been made. I shelled out a very small prostate. Then had difficulty passing the foley. After much time, to pass it from the outside in or the inside out, and much prayer. I finally got it from the inside out. I tied the larger foley to the tip of the other and pulled in the larger one in the correct direction. I was very relieved! I sewed up the bladder in two layers, then started the irrigation. Left a drain outside the bladder, closed the fascia and skin. The man seems to be doing fine this evening. To be sure his catheter does not come out, I sutured it to the abdominal wall from the inside with a large stitch! That way it won’t be “inadvertently” removed. Haven’t done that in this method before, but in the current situation, it seemed best. As in other third world places I’ve worked, doctors orders to place or remove a catheter are not always done. (my staff at home are great!)
About 7PM, I made ti back to the apartment. I had seen some ramen and Gillian said she had some lentils left over, so we combined and ate. Feels good to eat after 12 hours! We went back to the hospital to do a burn patients dressing change under ketamine at the bedside. That took a while. I decided to take call tonight to give her a break after 3 weeks of straight call. So I saw a few other patients the nurses had questions on then made it “home” at 11PM. Was able to skype with Audrey tonight! What a wonderful thing to have some electronics that worked in Africa!!! Now it’s 12:45 AM. Guess Ill shower, and sleep.
Thanks for all of your prayers. I really appreciate it.