Disaster response B #8
I am grateful, the next hurricane that is to come this way appears like it will be turning back out to sea before hitting the Bahamas. These people sure don’t need any more trauma than they’ve been through.
I’ve done a few inguinal hernias today and assisted in a hysterectomy for someone who has had vaginal bleeding for many months. It reminded me of the story in the Bible of a woman being healed because she had faith, and her bleeding stopped with touching Jesus cloths. I wish Jesus power was in me to stop bleeding or healing at a touch! That would be much better than the part I play now in the process.
Tonight I’m asked to see a guy who has a dialysis catheter in his groin that is infected. One was placed under his left clavicle before the storm but no one took out the infected one. This is bad, because if there is infection in one part of the blood stream, it will often infect the new catheter as well. I’m not sure why one wasn’t removed directly after the replacement was put in. But here we are. It seems a number of people we are seeing aren’t happy with the care they are getting on the island. We could be seeing the slice of people unhappy, or the care could be poor. Either way we are happy to take care of them and demonstrate Jesus love for them. I decided to take it out. I numbed up his skin and tried to dissect out the felt cuff along the catheter that holds it in. I couldn’t seem to do it from the opening that I had, so I made an incision along the catheter. I dissected it out and it still seemed stuck further on. So I did the same thing closer to where I expected the entry into the vein. Gradually it freed up and I pulled it out. Then I held pressure for about 10 minutes. He was supposedly on a blood thinner, but didn’t know which one. He didn’t really seem to bleed a lot, but I wanted to be cautious. The ER doc agreed to send him home a bit later on so I left to eat. (rice sprinkled with veggies)
New day. So a few days ago, after the operation of the person with extensor tendon injuries, I realized their thumb wasn’t working. Had I missed a tendon repair, or was there a nerve injury that explained that finding. So today the orthopedic surgeon and I explored the arm again. I opened up the closed incision. Next I dissected down to the tendon repairs. I was able to find the missed tendon and when I pulled on it the thumb straightened out. We extended our incision and couldn’t find the muscle belly that belonged to it. We did find the other tendon that ran the thumb and it was intact, so it must be that that one is denervated (cut nerve so it doesn’t work any more) So finally we attached the tendon end we found, to the extensor tendons that ran some fingers. So when she opens her fingers her thumb will open as well. At least this way she can open to grasp a cup or object.
Next there was a lady that returned to have her abdominal hernia repaired. She was done under spinal and did very well during surgery. After that was a woman who had fallen and landed on her foot. This fractured her medial ankle bone and her small leg bone (fibula), and ruptured some tendons. So I helped the orthopedic surgeon do the operation. She was put to sleep and then her leg was skin prepped all the way around up to the hip. Then we put the drapes on. We made incisions on either side of her leg, starting with the inside part. Her medial maleolus was fractured and so we were eventually able to turn the foot out to the side and then back and get the bone fragments to line up. Then we drilled, tapped and placed two screws to fix it. On the outside, where the fibula was broken we cut down to the bone and found the fracture. We bent a plate to match the bone and camped it to the bone (think something like a visegrip for the bone) Then we drilled holes. Measured each hole. Tapped each, and then put the appropriate length screw in each one. It’s like carpentry for the bones. Then we closed each incision
In the evening I was asked to take fluid off a lady that had a near white out of her right lung field on xray. So there was fluid around the lung. She also had a large abdomen, and a thin body. So she had ascites on exam. We don’t have a thoracentesis kit nor a paracentesis kit to drain these. So I had to improvise. The problem with that is, that the lung space has negative pressure. So if there is a needle or a cut in the chest, it will suck air in around the lung and collapse the lung. I had to place a needle, then remove the needle, leaving an angiocath, and then connect IV tubing, and then pull fluid from the lung space, push it down the tubing and start the gravity flow. It took about 1:30 minutes to get it drained. 1800 from the lung space, and 300 from the abdomen.
I made it to the food tent to find all the food was gone. Then I heard there were some people at Wendy’s. So they brought me a salad to eat. Now Ive showered, eaten, and going to hit the sack.