Chad #4 2019
The last two nights we’ve been awoken in the night for a C-section. Both for failure to progress and fetal distress. One got a living baby the other a dead baby. The one that died was bagged for 30 minutes then lost its heart beat. Then we decided to stop.
Last night I’m awoken by a knock on the door, to see a 18 year old guy who was in a fight and stabbed twice. Once in the neck and once in the right lower back. The nurse wants me to evaluate the back wound. He says the neck one is superficial. The back is deeper and he indicates about 1 inch on his own finger. He says that that wound bled a lot. I walk in to the “ER” which has been renovated since I was last here. It has a main entrance area that has a desk and three rooms with a couple beds in each. This guy is laying on his left side with a bandage on his back. I take off the bandage and put on some gloves. I tell him it will hurt, then probe his stab wound with my finger. I can get my smallest finger to go all the way in, angling down towards his pelvis. This could have entered his abdomen and hit intestine. So after probing the stab wound I feel his abdomen. He has no pain in his belly. They give me a suture and I put one suture in to re-approximate the edges leaving space for blood to come out. I kept him overnight to see how he did, and if he declines will operate on him. We have six cases already planned for today and already 3 for tomorrow. I have been busy each day from morning till 5-8pm with surgeries all day.
It is still unbearably hot in the OR. Yesterday it started at 95 degrees then went up to 101deg for the rest of the day. I got my hopes up as they found another air conditioner to put in the OR, but it felt cool for about 5 minutes after installation, then was warm all the rest of the day. I feel bad for Dr. Denae and Dr. Sarah who have been dealing with this heat in the OR for weeks. I am drenched constantly with my own sweat. I’m drinking a lot and don’t pee at all, all day. In the evening after drinking a few more liters of water, I finally pee some rose colored fluid. I wonder if I’m getting myoglobinurea from kidney damage. Now way to know, just drink more. The repair man has arrived this morning, so they will hopefully be able to get something working today. I don’t like wet cloths as, it contaminates the sterility of my cloth OR gown. But yesterday I decided it was getting wet either way. So before each case, I would remove my shirt and cap, rinse them, wring them out, and put them back on. This seemed to help a little. I’ve been making a little stink about the AC to the administration, in hopes that it will spur them on to have it fixed. I even told them I would stop doing elective cases unless it’s fixed soon. I don’t intend on following through with that at all, but they haven’t fixed it for Dr. Danae and Dr. Sarah, so why not push them more?
The last surgery of the day is most memorable. A thirty year old guy had been sick for about a week. Then about three days ago he stopped passing gas and stool. He looks very sick to me. Everyone here is thin, and when they lay down their abdomens are concave with ribs showing. His don’t show at all and his abdomen stands up taught. I take a finger and tap on his belly. With every percussion he jumps and grunts in pain. I check rebound by pushing in on his belly slowly, then letting go quickly. He jumps in pain when I let go. He has peritonitis so he needs to be operated on. Since I’m seeing him in the preop area as a consult, the OR crew which includes 2 nurses and 4 students, prepare him to be the next operation. He gets the usual fluid load before a spinal. I know he will need Ketamine instead because a spinal only covers the lower abdomen. I’ve given up on that fight with the anesthetist. He gives a spinal to everyone, and I’ve come to terms with that. After the spinal is in, Phillip preps his abdomen with betadine, while the other nurse and I scrub. We put on our cloth gowns and our cloth drapes and start in. I enter the upper abdomen after he has pain and is given ketamine. The upper abdomen is hard to get in to and everything is stuck. I cant seem to get very far and worry about cutting into a piece of intestine. Then I do something I’ve not done before, made a second incision in the lower abdomen. This got in directly and pus flowed out all over the bed, me, my assistant, and pooled on the floor. I’d guess about three liters. Now I’m not only drenched in sweat with all this stuff on and 101 degrees, but now I have pus on me and it smells awful. Even my terribly functioning nose cannot mistake it. This has been there many days, the intestines are stuck together making pockets of pus in various places. I eventually free up all the small intestine. I look it over and cant find anything wrong, I look over the large intestine- nothing. I dissect to behind the stomach- nothing. Front of the stomach- nothing. I feel the surface of the liver and spleen- nothing. I irrigate every thing out with a lot of saline. I’m quite frustrated as I’ve seen his whole abdomen and didn’t find the source of the pus. I close him up with another prayer that whatever caused this has sealed itself and will not leak any more. Disconcerting!