Bere 2018 #13
“Quesque tu fait ?” I am trying to figure out what’s happening as the anesthetist and the student nurse get the very old blind man off the OR table and he starts to squat to the floor. They kick a bedpan underneath him. At first I think that he needs to pee, then I hear it’s to poop. NO NO! Go outside. They stand him up and slowly go out to the preop area to have him poop in the bedpan. I don’t want to stand in that smell for the next couple hours as I fix his strangulated inguinal hernia and his accompanying hydrocele. I also don’t want that contamination in the OR. Though it seems that frequently when someone gets their spinal, at the end of surgery there is poo between their legs. Finally he finishes and they get him back on the OR table for his spinal anesthetic. He has had an incarcerated hernia for about a week. His scrotum is nearly the size of a US football. The cautery grounding pad doesn’t seem to be working so I disassemble the connections and recreate the metal grounding pad. It works. He is prepped and draped with cloth drapes. This pack they had resterilized paper gowns, so I feel like I’m in luxury with sleeves long enough for my arms. As I get down to his hernia and open it the identifiable structures are difficult to find. I identify the fascial layers and the nerves. But the cord structures with the hernia sack is really edematous and difficult to figure out. After dissecting around for about 15 min. I finally enter the sack. It seems to have intestine stuck to one wall. After about another 15 min, I figure out that it seems to be a piece of large intestine with the appendix on it. But the intestine occupies one wall of the hernia sac and I can’t separate it. I kind of close it back up and then am able to reduce it back in the abdomen. I compete the suture repair of the hernia and then look at the hydrocele. As I dissect around the testicle, there isn’t a hydrocele, just a lot of edema. So I put it back in the scrotum. I close up the various layers finishing the surgery.
There was a lady that came in with a low hemoglobin 4 (normal >12), and received 4 units of blood last night. Today she is 6 (should be around 8). Her belly is distended and tender. I decide she needs an exploratory laparotomy. Eventually they get her form the ER to the OR and she is the first surgery of the day, well before the one noted above. Phillipe (anesthatist) gets her ready as I make rounds. I send home a number of people. Some of them just have dressing changes and have been here a long time. After she is ready, I call Dr. Sarah and she is done with rounds, so she joins me. Since her pain started all over her abdomen, Im not sure what I will find. So I make an incision in the middle of her abdomen. The blade seems dull for her tough skin. When I get into the abdomen yellow fluid comes out. There seem to be adhesions everywhere. They are fairly weak adhesions and most I can just divide with my fingers. I don’t see anything obvious for a while, so I keep looking. I don’t see any pus, no stool. Eventually I look around the stomach after extending the incision up as high as I can. Then I see some dark tissue on the anterior stomach. Eventually I see mucosa coming out a hole near the pyloris (exit of the stomach). She has a perforated stomach ulcer that is huge. I try to decide wether to close it or just cover it with omentum. I do both. Freshen up the edges. Reapproximate the edges and then suture up some omentum over the area. I have the anesthatist put in an NG tube and I leave a drain through the abdominal wall to the area as well. She will need antacids too!
I’m sound asleep. I hear tapping, and eventually am conscious enough to realize it’s someone at the door. I look at the phone and see I’ve been asleep about 45 min. I get dressed and walk outside. The moon lights up the sky and ground. The maternity nurse says she has a woman in the delivery room that bled a LOT at home and continues to bleed here. She thinks she is near term pregnancy. She doesn’t hear the babies heart beat. She did a vaginal exam and felt what she thought was placenta. Diagnosis: placenta previa. This is where the placenta covers the birth canal and as the cervix dilates, the placenta starts detaching from the uterus and bleeding. This often kills the baby and can kill the mother as well. I am AWAKE NOW! I follow her in, and get the ultrasound on my way. The 25 year old girl is lying on the delivery room floor, having just vomited on the floor. She lays in a puddle of blood and blood is all over her wrapped skirt. I put the ultrasound machine on the floor and squat beside her and do the ultrasound. I find a baby that is alive but 32 weeks and has a heart rate of 71 (normal is 130-150). This baby is dying, and is to early to live here. No neonatal ICU here- just mom and grandma giving him breast milk. The girls hemoglobin is 6 and I think this is falsely high. Her eyes could not be any more pale than they are. I see NO vessels whatsoever! I call he anesthetist to come in and figure ill call Dr. Sarah too. Then one of the student missionaries, Diana, comes by and she says she can scrub with me. So I scrub with her, and let Dr. Sarah sleep. She is blood type A-, and I think, it’s unlikely we have any blood that may work for her. Fortunately the blood bank fridge is in the OR, so when we get her in there I check. Yesterday we had a woman who had an ectopic pregnancy and we gave 4 units of blood to. Everyone the lab tested was A and the patient was O. They gave anyway, and we used O from our fridge. Now I see that God was working everything out YESTERDAY! As I look in the fridge, I find 5 units of A- blood. WOW!!! I hang one, and the anesthetist gets there soon after. We have a unit of blood going on each side, wide open. We do the usual prep and drape with cloth and I pray out loud and start. As I cut into the abdomen she bleeds, but I can tell it’s diluted blood. It almost seems see-through and doesn’t coagulate. I use cautery and clamps, and cause as little blood loss as I can. I cut into the uterus- and it always bleeds a lot. Then I pull out the baby. I strip the umbilical cord towards the baby to give it as much blood as I can. I hand him off after cutting the cord. He is trying to breath- Im not hopeful for him. As I close up the mother, I see the baby moving a little but no sounds. The nurse says he’s breathing. I ask God to save the baby again. I finish up and the mother is doing well. The baby has been taken out to the family and I head to bed.
The next morning as I get to the hospital I ask about that baby. I am told that he is doing well and has breast-fed already! PRAISE GOD!!!! A miracle!! I couldn’t have imagined he would ever make it.
for more mission stories visit our mission website www.missiondocs.org
for information on our missionary and pastors oasis visit www.lifeimpactministries.netand click on Safe Haven Oasis