Bere 2018 #15
The first thing I do when I get into the hospital this morning is to check on the woman with the tracheostomy tube. The student missionary, Diana, has taken good care of her throughout the night. She has suctioned the tracheostomy a number of times and the woman is awake and not pulling on it. She is motioning that her stomach hurts. I try to have her sit up and swallow some water. It obviously doesn’t go down well. She is struggling to swallow. I’m glad I put a trach in her and wish I had a bronchoscope and EGD to look at the internal parts of the repair. I wish I had a tracheostomy with a number of inner cannulas. These are the parts that are changed out when they get plugged with secretions. Do I need to make a big hole in her neck so that it cant close up for months? The family didn’t even want to get her antibiotics. They said that the person with the money was coming. But when they arrived they didn’t go to the pharmacy. Eventually after they talked to her she grabbed the roll in her skirt and gave them a key. I assume that is to wherever she keeps her money. I told the men around that they should be ashamed of themselves. That their momma has to pay for her own care when it is the mans job to do so! (at least that’s culturally appropriate for men to do here, they are the ones with money). I discuss with them many times during the day to go and purchase the medications. I still don’t know if they actually did it like they said they were going to.
I do dressing change rounds (surgical rounds) on the surgical ward then do rounds on the medicine ward. Then I go to the “ER”, a room with 6 beds in it lining the walls. There are no diagnostic machines, no monitors, nothing that demonstrates this is an ER other than it says “Urgence” on the wall outside. I’m asked to see a guy who came in last night with a tender abdomen. It’s been tender for 3 days. As I talk to them I lay my hand on his belly. He winces. I give a slight tap with a finger, he grimaces. I do a normal exam, and he has a rigid abdomen. All signs that he has perforated intestine. I need to do a digital CT. here this does NOT refer to a CAT scan like in the US. It refers to cut and touch with fingers. So I put in all the orders into the ipad (they have a simple system called Open Kims, that was donated and is very useful.) So I put the orders in and the family goes to the pharmacy to purchase the medicines. When he has paid and gotten the medicines- His bill comes to about $150, they get him ready with a spinal and urine catheter. Dr. Sarah is done with rounds and so she joins me. She does the majority of the surgery. As we get through the skin, non-existant fatty layer, fascia, and peritoneum we then get pus. As we look around feeling for something that might be suspicious we don’t find anything by feeling. So we start pulling out the intestine out of the incision and look for holes. In the distal small bowel, we find a small hole in the intestine. I freshen up the edges, excising the hole and making it a little larger with good edges to close it. Then I close it with interrupted silk sutures. As we look around we find two other spots that are soft and necrotic and nearly holes. So we excise these two spots and Dr. Sarah and I close them. WE wash out all the pus we can and clean the intestines. We put them back inside with difficulty as he also has had ketamine from the start as the spinal didn’t cover that high on his abdomen. It’s kind of like the patient is doing a sittup, his muscles are real hard. Eventually I shove them all in and we are able to close the abdomen.
I’m very frustrated tonight. I got called into the hospital to see a 2 year old boy who has a rectal prolapse. This is when the rectum turns inside out and sticks out the anus. I also have seen an intussusception present this way. This is where the intestine invaginates on itself and sucks one piece of intestine into another. So I suspect this is more likely. I walk in by the light of the moon with my headlamp off. I go to the peds area where they receive kids. There is a mother with two guys and a child with lying on his belly, with a wet cloth covering a bulge at the anus. I lift the cloth off and see a looped piece of intestine sticking out the anus. As I feel around it at the anus, I’m convinced that this in an intussesception. He needs surgery to remove dead intestine and to reduce whatever intestine is still living. I do the usual things of asking the family to go to the pharmacy to buy medicine and pay for surgery. The total comes to an equivalent of $120. They say they have no money, as everyone says, and I say they should go to the pharmacy or send a guy home to get it. As I go to the maternity ward, there is a pregnant woman there that the nurse is not sure if it is a head presentation for a delivery. I take her to the ultrasound room and confirm that she is a cephalic presentation. Then I check on the woman with a tracheostomy that is now on the surgical ward and has a suction sitting on the floor next to her. She is breathing fine for now. I head back to peds. The family has left with the child to see what his uncle can do to help them pay the bill. I am very frustrated. I want to operate on the child. I also want to respect that the hospital needs to pay its bills and workers, and therefore needs paying patients. I feel like I have failed to show Christ’s love to this patient tonight. Would Christ pay the bill for them? Would He help create the feelings of things being done for free at this hospital? No he would put a hand on them and it would be healed. I guess I didn’t think of asking Him to heal the child in that moment. I am praying that they will return soon to allow me to operate on them. I am praying for healing now- though that feels woefully late. Again, I look forward to the day when the pain, sorrow, and sickness of this world are gone, and you and I can live forever in peace and health and joy with God for all eternity.
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