Shanksteps Bere April #5
In the late evening Im asked to see a guy with significant abdominal pain. He says it started in the upper abdomen and then progressed to everywhere. He’s quite tender in the upper abdomen and seems distended. he has an inguinal hernia that is easily reducible. He says he hasn’t passed gas but did have a liquid BM that day. He’s had nausea but not vomited. Then nurses had asked for an ultrasound and I think instead he needs a abdominal X-ray. On the X-ray i don’t see any evidence of obstruction nor free air. So I decide to treat his typhoid and see him in the morning.
In the morning he is still very tender and I think I should do a Bere “digital CT”. Meaning digital (finger) cut and touch. So i ask that he be the first one fo the day. So they get him ready and I open his abdomen. I get a bunch of fluid that i think looks like it may have come from the stomach. So I go there first. I look all over the stomach, front, open the back area, follow down the duodenum around the C curve of the duodenum. It’s difficult and it takes a while. I find areas of inflammation and swelling in the tissue but no hole. I run the small intestine from start to finish and see no problems. I finally realize that everywhere Iv’e seen the inflammation has been most near the pancreas. So that’s his diagnosis- pancreatitis! I feel the gallbladder and don’t feel any stones. It’s also small and not distended so I think i get a pretty good feel. So i put drains in and close him up. We don’t have any pancreas labs, so will have to rely on how he feels and when his intestines open up. But there is nothing to do but watch and wait and hope that he heals. Im praying for many of my patients. God heal him!
The next patient Dr. Denae did I assisted her on. It was a 30s year old woman with cervical cancer that was very hard and filling up the exit of the uterus. She was bleeding and her baby was about 30 weeks along. She had broken her water the day before and contractions had started. So we needed to do a C-section because this baby had no way to be delivered vaginally. The patient is having a lot of back pain and can’t sit. So dong the spinal is very hard and we attempt to do it as she lays on her side. The nurse tried, I tried, Olen tried- no go. So we gave a bunch of local at the incision site and started. We wanted to give the Ketamine at the last second so to have minimal effects on the baby. We got our a crying normally formed baby. In the lower uterus there was very soft tumor that was bleeding. We closed her up and pray that she stops bleeding to have some time with her child before the cancer takes her.
The next one is a guy who had a bladder stone. It was removed her about 2 weeks ago and then the urine catheter plugged up and overfilled the bladder. Then the front repair fo the bladder ruptured. So he was taken back and repaired again then developed a leak about a week ago. Now we took him back to repair that leak. It was terribly stuck and difficult to create any planes of tissues that could be evaluated for closure. Gradually we found layers to close. We flushed the catheter with fluids and it didn’t seem to leak, so hopefully it will stay that way.
The next one was a woman who had an injury to her middle finger and the middle joint was stuck straight. So when she made a fist it stuck out and was in the way. So I offered to take it off completely or leave her with a small stub that may help some. So she said a stub would be ok. So i numbed up her finger at the base. Once here finger was asleep, I cut through the tissues down to the bone. then I nibbled away at the bone with rongours. Made the end smooth then sewed the skin edges back together.
More happened than that, but that’s what comes to mind. Pray for staff and patients here that they would really know God and follow His lead in their lives.