Chad #3 2019
It’s outrageously HOT!!! As I’ve mentioned the AC in the operating room isn’t working. I drip constantly with sweat. Sometimes it drips on the patient I’m operating on, contaminating everything. A fly persistently landed on a patient mid-surgery. The coolest it got was this morning about 7 AM when it was 86 degrees. Mid-day it was 95 outside, hot compared to my 65 on the US west coast, but it got up to 101 IN THE OPERATING ROOM today and stayed there for the remainder of the day. They have put in a fan that was blowing on me or my assistant, whomever was on that side of the room. I never imagined an OR could be sooo hot. In the US most OR’s are mid sixties. With all the mask, hat, gown, and gloves, even in the US I get hot sometimes, here…
I type as I sit here at 10 PM waiting for the OR crew to come in for a strangulated inguinal hernia in a man that’s had pain since mid afternoon. I have a fan on me and my apartment is 90 degrees. I’ve stopped sweating, I hope that Ive hydrated enough that that may not be the cause.
My first case this morning was one that came in a little bit ago. The 8 year old boy was apparently clawed by a crocodile. He had puncture wounds on his abdomen and in a semicircle on his back. To me it sure looked like a bite mark, but the father insisted it wasn’t a bite, but the croc clawed at him. He had omentum sticking out an abdominal puncture site. I put in local anesthetic after prepping him and we put the cloth drapes on him. Phillipe the anesthetist didn’t want the patient to watch so he taped his eyes shut. That bothered me, and I asked him to either remove the tape or to give him some ketamine so he wouldn’t remember it. I cleaned up each wound and was able to get the omentum back in the abdomen and close the fascia.
Second was a back wound that had been cleaned up with dressings and another doc wanted it to be closed somewhat so that it would heal faster. It was a difficult thing to do. I imagine it will get infected and likely drain for a while anyway.
Third, was a C-section for triplets. They were doing well, and it was time. So Dr. Sarah and I took her to the OR. The incision was the usual phanynsteal (low transverse) incision. As we used the scalpel to enter the uterus the amniotic sac bulged out. We poked the sac and amniotic fluid poured out. The baby was in a breach position. The second sac, had a baby with a head first position. Feeling around inside, there weren’t any other babies. Guess we should have had a look with the ultrasound ourselves.
Fourth was a C-section for a woman who had been in labor a long time and wasn’t progressing. It was her first child. We pulled out a limp baby. Dr. Sarah came in the OR to help revive the baby. The baby was bagged for more than 30 minutes, the heart stopped and they stopped trying.
I ate supper then later on was called to see the ER patient. He was about 50 years old and cried out in pain every 5 minutes or so. Apparently he had a strangulated inguinal hernia. I followed the nurse who called me to the ER. He lay there calmly on his side. His pain had gone on a few hours and I decided to try to reduce the hernia. I looked at a scrotum that was at least 12 inches long and about 6 inches in diameter. The firm large part was off to the left side. The right side was shorter and smaller. I cupped the hernia and tried to massage it back in. Circle motions, change in position and there was no success. The family of the bed next to his wanted me to see their patient. He was about a 60 year old guy that couldn’t pee. Someone had attempted to place a urine catheter at another hospital in Kelo and then when they were unsuccessful, they put a needle through his low abdomen into his bladder and drained off 500ml of urine. Then they sent him our way. The nurse had attempted to place a catheter here, but was unsuccessful. So I took a catheter and slowly pushed it in. There was a lot of resistance, but eventually with steady pressure it gave way and entered the bladder. I imagine he either has an enlarged prostate or a bladder stone. Will get an ultrasound tomorrow to evaluate it.
The ER nurse called the two OR guys and their phones were turned off. So he had to get on his motorcycle (moto) and go to their houses and get them. I went back to my apartment and waited there. Once they arrived they came to get me. In the OR it had cooled off to 98 degrees. After the spinal and prepping the scrotum and everything else, I started my incision. I am continually amazed at how the local scalpels cannot cut the skin here. In the US one swipe with the scalpel and your through the skin and into the fat area. Here, I have to cut about 3 times just to get through the skin, and that’s pushing real hard. Granted, their skin is tougher, but still its ridiculous. As I went through the different layers I eventually found and dissected out the hernia. Opening the sac, I found intestine that looked dark. After I pulled it out, I realized it was going to make it. I had difficulty putting it back inside and had to make the hernia site even larger, to be able to shove it back in. Then I went through repairing the different layers then about midnight, back to bed.