Chad #5 2019
In between surgeries I try to see consults that are waiting outside the OR for a doctor to see. Whoever is seeing consults usually does it in the “preop/postop” room. So the room is kind of a zoo. Usually one or two preop patients area there with IVs running, and a postop patient. The room is about 18×15 ft. Then to them we add in the consultations. Most people don’t seem to care about privacy, but sometimes an many may turn away from the others to show me his hernia. Occasionally there is a vaginal exam, and for those we usually send everyone else in the room out. So I’m in-between cases and seeing a few consults as they get the spinal anesthetic for the next hernia patient ready. There is a 14 year old girl that I’m asked if Id do a breast reduction. I say sure, but why would someone need that here? This is often cosmetic in the US but can be for very large breasts that give someone back pain. I look at this girl and she is about 4ft 8 inches tall. As she sits in the chair her breasts are the largest I’ve ever seen under her shirt. I’ve not even seen any that had huge implants be this large. As she lifts her shirt I see that they are sitting on her legs. They are HUGE, I estimated about 15 lbs each. WOW, no, I really don’t want to do this. Especially in someone who hasn’t had children and will need to breast feed in the future. There must be a hormonal problem to cause this! I hear there is a plastic surgeon coming with an anesthetist and a team in November, so I decide she would be better served by waiting till that team arrives. They are a little unhappy at the wait but accept it anyway. Apparently her breasts have been getting bigger over that past 1.5 years. I encourage them to fabricate or find a large bra to help, I seriously doubt anything that size is available anywhere!
Between other cases I see a kid with a tumor growing on his mandible. The teeth there are splayed out and feel loose. His upper lip protrudes forward and I think this may be Burkett’s Lymphoma. Whatever his diagnosis, we have no medicines for it and say there may be something in Ndjamena. They look at us blankly, knowing they have no ability to go to Ndjamena and get treatment.
I remove a large prostate and then am asked to see a guy in ultrasound. Now he has a BIG prostate! It fills nearly his whole bladder with about 10x10x10cm of prostatic cancer. He came to be evaluated because of hematuria (bloody urine). The only thing I can offer his is an orchiectomy (remove both testicles) as testosterone stimulates prostate cancer growth. I leave to go back to the OR before he has come to a decision.
I do another large hernia that makes the scrotum look to be about a liter and a half in size, then I see a boy that has a lump on his right mandible and a mass in his mouth. As I peak inside I see some teeth going different directions and a hard pointy lump underneath. I suspect this is rotten mandible that is pushing up. I have he and his dad go to the pharmacy and pay for a sequestrectomy, and I think that comes to about 25,000 CFA ($50). Later on I see them after a couple more surgeries. We bring into the OR, give him a shot of Ketamine, and I probe around with my finger. It feels mobile but I can’t quite grab it. I get a Kelly clamp and grab it, rock it back and forth and out I pull a piece of rotten mandible with a tooth in it. I see another tooth heading towards the back of his mouth with it’s full roots exposed, so I grab that and rock it back and forth then yank it too. I shove some gauze in the hole and we take him back to the room I originally saw him in- preop/postop/consultation room.
I see a guy in-between cases that can’t pee well. His ultrasound says he has a small stone in his bladder. He says he hasn’t peed for 2 days. His bladder is full but not up to his umbilicus like I’ve seen before. I get a foley out of the OR and try to put in his penis. It gets about half way down the shaft then is blocked. I ask him how he pees, and he conveys what sounds to me like drops coming out. I think he must have a stricture. I get the smallest child’s foley, and it wont go I either. I tell the OR crew that we need to operate on him. In a few minutes they tell me he is peeing a little and is not blocked. I decide to wait till morning, as it’s already late and I’m hoping he will make it till then. The next morning, he sees me on rounds and wants reimbursed for what he paid to have the surgery. Apparently he peed some blood then he had normal flow after that. He must have passed the stone.
