The intensity has picked up around here. Our new students are wide eyed and eager. Susanna and Charlotte are Swedish women going to medical school in Poland. Second and third year they have, surprisingly, almost no clinical experience and none in surgery. It has been interesting watching Catherine, who has not yet been to medical school, orienting them as to operating room protocol and procedures. That girl learns so fast it\rquote s almost frightening. I'm really proud of what she has accomplished the last four weeks. I hope she chooses surgery later on because she's good at it and is definitely temperamentally suited for the field.
It's fun having a class now. Our new students have the academic background for me to explain things in medical jargon and to coax out answers to questions based on what I think they should already know. Actually, they're not bad though Charlotte as a third year is more advanced. Their English is almost southern California. They learn our language almost from birth and watch a lot of American television. Anyway, they walked into a storm of clinical activity. Surgical cases are coming at us thick and fast. It's necessary to pick and chose the cases I want to do in the limited time I have left here. We can only do three a day and I have just three days left in which to work. Tomorrow we will tackle a case of what is probably colon cancer (remember, clinical diagnosis only, no x-ray help) and a weird neck cyst about he size of a large orange that keeps recurring and who knows what emergency will show up. The new girls will alternate assisting as it seems Catherine has become the darling of the OB department and has taken to first assisting the two or three caesarian sections that happen each day.
I'm going to relate another very weird story now. About three o'clock this afternoon we were called to see an elderly man who had been hit by a falling tree several days ago. On his right side there were four fractured ribs and his collar bone was fractured and the ends collapsed and overlapping by at least two inches. Either the ribs or the collar bone fragment had pierced his chest and the lung was 80% collapsed. We took him right to the OR to reduce the fracture and apply a brace to his shoulders. He also needed a tube in his chest to re-expand the lung. Luckily, one modern chest tube with an introducer was available. As we were starting our procedure the next case, an emergency caesarian section was brought to the operating room door. While she was waiting there she delivered spontaneously and suddenly we were surrounded by people running around trying to resuscitate the baby, tend to the mother and keep the equipment going. After reducing the fracture and prior to placing the chest tube I sensed things were not going well and stopped what I was doing. Moving over to the nurse who was frantically trying to revive the infant I began external cardiac massage while the nurse administered oxygen. Now all this was going on in a room less than 20 feet square. The infant did not respond and after 15 minutes I abandoned CPR and returned to my patient placing the chest tube uneventfully. When it was all over I turned to the students and told them to remember this day because they will probably never experience anything quite so bizarre.
That case finished all that remained was to tap into the chest of the young woman with the toe amputation two days ago. It seems she had developed massive fluid around her right lung and was having a lot of trouble breathing. We had no idea of why this was happening but it was clear from the chest x-ray we managed to get by sending her over to the other hospital that something needed to be done fast. Over in the ward we simply stuck a plastic covered needle into the chest, removed the needle and left the tube. Minutes later about a quart of fluid had drained, she was breathing better and we could all go home. From the looks of the fluid we're considering TB aggravated by anesthesia and surgery. We can get the fluid tested to make sure and if we\rquote re right she\rquote ll do well with treatment.
We really hadn't expected the students to come as I had suggested that they be sent to another hospital because they were arriving so late. Jasper has arranged to go on vacation during the middle of next week. Fortunately there is a young man her, Dr. Haan, who is practicing internal medicine and pediatrics. I had met him only briefly and had mistaken him for an assistant medical officer. Fortunately not only is he a highly qualified doctor but his English is pretty fair too. He has agreed to take over responsibility for the students after Jasper and I are gone. We have a meeting tomorrow morning to arrange the details. By the middle of next week I think Charlotte and Susanna will have had enough of surgery anyway.
It's time to start arranging the details of my departure. I sent out the last batch of laundry, had a new pair of jeans altered and some dry cleaning done. Now I need to decide which clothes to take back with me and what things to leave behind. There is still more work to do here and I plan to utilize all the time remaining. I'll post my final thoughts on Tanzania from Dar es Salaam on Monday. There is a not so enjoyable two day bus trip in the meantime. Hopefully I'll get a private ride for the first half.
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