Chad #13 2019
I feel terribly cold!!! It’s 88 degrees in my room. I just woke up from sleep and I’m freezing. After a day of operations there was a soccer match between the health workers (hospital employees) and the teachers. Dr. Olen played with the hospital workers and the health workers won 4:2. Yeah! It was a good match and there were probably 100-200 people on the sidelines. The referee was a teacher, and you could tell, from the way his called favored the teachers, especially with off sides calls. It rained during the last half of the game. So all that is the first time I’ve felt cold here. Back in my room I warmed up and felt rather tired and went to sleep. Around midnight I woke up feeling real cold. I put scrubs on and wrapped myself in a sheet and lay on the futon for a little bit shivering. I realize I’m getting nauseous too. That’s strange, that rarely occurs. I vomit a few times, and then I get diarrhea too. Have you diagnosed me? I had! The only time I feel cold in hot places, is when it’s raining, or when I have malaria. I also wonder if eating bule at the elders house may have given me dysentery, though the vomiting and diarrhea can be symptoms of malaria too. I decide to go into the hospital and get a malaria test. So bundled in my sheet I head in. On my way I bump into Dr Stacey as she goes in to transfuse a little newborn with a hemoglobin of 3, and ask her if I should start malaria treatment. She asks whether I have a fever, and I don’t think so, but don’t have a thermometer. She offers to lend me one when she gets done. I go to the ER and have the nurse take my temperature 37.8C and start a little “carnet” medical record booklet. Then I order myself a GE (gutepece) which is their malaria test. As I go into the lab, I see the lab guy and a girl watching an English video of those competitions where contestants run up a wall, hang from bars, bar walk up the “salmon ladder”… on a laptop computer (I cant think of the name, but it’s real common). It seems weird to see that here. He pricks my finger for the GE and says it will take a half hour. Stacey swings by so I go get a thermometer from her and she recommends if I go over 101.5 I should start treatment. I head back to bed all wrapped up and with my scrubs on. I turn OFF the fan for the first time while I’ve been here. My temperature is now 100.9. I vomit again and have some more diarrhea. I sleep a few hours and wake up sweating. I take off the sheet and am about the right temperature in my scrubs. I drift back to sleep and awake sheep bleating and cats meowing. This is a common way from me to wake up as Dr. Sarah and Gabriel have sheep that roam around and there are cats that used to be fed in my room, so they are constantly around begging. I feel a little better but still wiped out. I have a little more diarrhea but the vomiting has stopped. After the morning worship I tell Olen, Stacey, and Sarah what’s gone on, and Olen looks up my GE and it’s positive, I do have malaria. Sarah offers her own stash of Malerone from the US as treatment. That is great, because it has less side effects than quinine, which is what I planned on taking. I will try to get some in the US to replace it for her.
On rounds I see my various wound patients, some are postop and some are ulcers that are being treated. I feel rather worn out, so I sit down on patients beds often as I talk to them. I try to keep hydrated, and so am drinking water and also Foster Clarks pineapple coconut drink, I got from the market. I really want ORS oral rehydration solution, but there is none here at the hospital. ORS is similar to pedialyte in the US and is used for rehydration from cholera and other diarrheas. After rounds I head to the OR and will try to do a few cases. They aren’t’ ready yet, so I see a few consults.
The first case is an ostomy reversal that Dr. Danae wants to do with me. So we scrub and I assist her. It appears to be a loop ileostomy. She had called the previous surgeon to get information about what he did in Ndjamena, as nothing about the operation was written I the patients carnet. Apparently he was not very helpful with saying what he did. We cut around the ostomy and freed it up from the surrounding adhesions. Then we created an anastomosis between two loops of bowel. About this time I was feeling like diarrhea was going to hit me again. So I asked Dr. Denae if I could leave and have Abouna scrub in. She obliged. I went back and after a couple more bouts, I lay on the futon to rest. It was about 102 in the room and I lay there with the fan on me and sweat! I slept a couple hours. After dark I got a call from Dr. Stacey to help with a patient. The lady was in labor and had a dead baby with an arm presentation. This is a terrible presentation as it means the head and the butt of the baby are up higher in the uterus and the arm and shoulder are what is trying to come out. The lady was given fluids and then Dr. Stacey and I each tried maneuvers to change the position of the baby in between contractions. After 20 minutes of trying, we aborted that idea, and did a C-section. Once we opened the uterus, it was still hard to get the baby out as we had to reach up from the lower uterus to get the head still. Eventually we pulled out the dead, starting to decompose baby. Inspecting the uterus, I discovered the right uterine artery had torn in two. So the first thing I did was suture that artery to keep it from bleeding. Next I controlled a few other bleeding spots that weren’t in the coming suture line. After controlling the bleeding, I closed the lower uterus and sutured the bladder to it’s previous place. When we came to skin I asked Dr. Stacey if I could leave as I was feeling weak again. I went back to my room and had more diarrhea. I showered and went immediately to bed. in the morning, I felt better, but as soon as I started eating again, the diarrhea began. I started Cipro and Flagyl right away, as I know in a couple days I will be on the all day bus without a bathroom and can’t afford to be having diarrhea, as they don’t stop except maybe twice all day.