I’m spent mentally but am happy too. I asked special prayer from some of you that i had whatsapp contact with and God answers prayers. He doesn’t always answer the way I want but today WAS the way I wanted. The boy woke up after the surgery and could move his legs. I intubated him at 9:30 AM and we extubated him at 4:30 PM. Phillipe and Ndilbe couldn’t figure out the new anesthesia machine for the vent so they bagged the patient on isoflurane for the entire time.
Andrew (the missionary surgeon here) and I have been planning this surgery for a few days now that we were able to see the CT scan. I saw the kid in the outpatient area a couple weeks ago and Andrew sent the boy to Ndjamena to the government hospital for a CT scan. The boy had a huge mass on his back. its been growing since he was 5. He and his father went to Ndjamena and spent a week trying to get a CT scan done and apparently did other tests that whomever they saw ordered but the CT was never completed. So last weekend the local chaddian doctor took them back to Ndjamena and took them to the hospital and with his contacts there, got the CT done and onto a USB drive so we could see the images.
We saw what looked like a mass coming from the spinal canal about L1,2,3 as the spinous processes in that area were deformed. We decided to try to take off this mass and so that was the only surgery we planned today.
In the pre-op area i talked to the boy and his family about the complications that were possible. I spoke to the chaddian doc, who talked to the boys uncle, who translated again to the boy and his mother. I mostly wanted them to know that he could bleed to death or be paraplegic afterwards. They understood and wanted to proceed.
After he was asleep, we turned him prone, which seemed to make me more nervous than the two doing anesthesia. I marked the large vessels in the mass with a sharpie so i would know where they were after prepping. We washed his back and the mass with soap and water then prepped it with betadine. Then I put on the sterile drapes. I cut first with a blade, to see how much bleeding would occur (a way to check where there is no bleeding times or INR…, then I used cautery. As we came to large veins Andrew and I would ligate each of them. Small ones we cauterized (electrically burned). We created a flap above and a flap below to allow enough skin to cover the hole that would be left after we removed the mass. We then gradually cut down on either side till we reached the back muscles and then cut towards the center. We intentionally left a bit more tumor in the center of the back were we suspected the nerves of the spinal cord could be present. After the tumor was removed it weighed in at 37lbs. I gradually got the skin edges together for closure. It wasn’t pretty as the line made kind of an “S”. I guess I cant cut on two sides of a LARGE thing and get it to look as good afterwards. for a breast tumor I do much better. We kept him deep on anesthesia till we could flip him back over. Then he took a while to wake up. Eventually he was able to be extubated. He moved his legs!! Yea!! Thank you Jesus!
