Shanksteps Bere 2017 #6
It’s Sunday and Audrey just had to leave this morning. I’m missing her already. She, Deborah, Jent all left for home today. I wish Audrey could’ve had the time off to stay with me the whole time, but am also grateful that she was able to come at all. Olen dropped them at the bus station about an hour away this morning. I woke up early to see them off. It is to quiet now in the place I’m staying.
I head in to help with rounds after eating some pancakes with Dr. Rollin and Deloris. Pancakes with peanut butter and mango sauce. I’ve not even walked into the surgical ward with the stench hits me! Now I’m not one to be bothered by smells as my nose I inherited from my dad. That means it doesn’t work all that well, which in my line of work is usually a benefit. In the US, nurses may be retching around me and I’ll be doing just fine. But this one was strong! I walked in to see Christian changing a leg dressing. There lay an old woman on a bed, clouds of flies swarming around her, writhing in pain, as Christian loosened the bandage on her rotten leg. Pus flowed down her leg, across her bed and pooled on the floor. She had been admitted the night before and we were looking at it for the first time. We immediately felt like she would likely need an amputation, but could start with a operative debridement to evaluate it further. A new dressing was placed and we continued on rounds. There were many wounds to dress. Were they infectious tropical ulcers, burullies ulcers (from tuburculosis), a spider bite necrosis, a snake bite… So many options as to the causes of things that look similar. Most improve with dressings and proper care. The 23 year old woman without children that I took out two uterine fibroids, one the size of a large grapefruit the other an orange, was doing well. I doubt she will be able to have children even with them out, but at least she still has her uterus. A woman who cannot have children is not valued at all in this society. Their worth is their children. Usually when you ask a woman how many children she has, she will answer, “I’ve had 8 children and 2 are living.” This was the response yesterday when I asked a woman. So still having the chance to have children is very important to the 23 year old. We see the man we drained a psoas abscess on. He looked like death warmed over when we operated on him. He appears to be doing better and is in pain but better. His drains are working. Of course he is in pain! We only have ibuprofen and Tylenol to treat pain here. But every one of my patients here is up and walking the next day! It sure is nice not to have the negative side effects of narcotics though.
After rounds Christian and I head back to the OR to debrede the old womans leg. Now the OR smells like the surgical ward did. Somehow the masses of flies didn’t make it in there with her. [As a side thought: There are sterile flies and non-sterile flies. Non-sterile ones- are those that fly around the operating room landing in the open abdomen of the patient or on the sterile field. Sterile flies- are those that are cooked in the autoclave and found in the sterile pack when it is opened at the beginning of the operation.] It is useless to prep her leg with betadine to make it “sterile”, but I do it anyway. Pus drains onto the area I just prepped. I kick a trash can to the side of the OR bed just in time, the lake pus on the bed, drains into it. She has an open area about mid-calf that has granulation tissue but pus pooling around it. I probe with my finger and the skin is separated all around. My finger easily goes from the wound up to her knee and way beyond where I can reach going down her leg. We open the spaces. She ends up with open areas from her knee down to her ankle on two sides. Necrotic tissue and pus is removed. I know I will smell like pus, until I get a shower and change my cloths. Sometimes the smell clings to my nose even after that! I think she needs her leg removed, but will wait a few days before telling her that. It is easier for the patient to accept bad news when they have come to the same conclusion themselves. I see a few other consults and prepare them for surgery in the upcoming days.
I head home to shower and get the stentch off of myself. The cold shower feels wonderful!