Back To Work

July 15

Yesterday and today were surgery days. They were not as full as we would have liked because during construction here we need to share an operating room with the assistant medical officers who do Caesarian sections. There are many of these because the level of pre-natal care here is abysmal. The AMO’s have figured out that if they get here early they can start before us and we end up waiting to use the OR. It has decreased out workload considerably. We spend the down time in the clinic seeing new patients in hope that we will be able to fit them all into the surgical schedule. Some updates: “Spinach Lady” had complications and needed to be returned to surgery. We wound up having to remove half her stomach. The operation actually went well but she is so nutritionally depleted that the outcome is in jeopardy. In the States we would have her on total intravenous nutrition but no such capacity exists here so he will have to make it on her own with simple fluid replacement. It all depends on her reserve and because she is young and strong I am hopeful. All of our other cases have gone smoothly and are doing well.

A young boy of six was presented to us last week with an enormous mass in his abdomen. Diagnostically all we had was an inadequate ultrasound exam so we went into the case not knowing for sure whether it was an enlarged spleen or a kidney tumor. Unfortunately for him and us it turned out to be kidney and presented an operation that would have been formidable in the most sophisticated of settings. The mass, called a Wilms tumor, was about the size of a regulation football trapped in the abdomen of a 40 pound person. Ara and I worked together for about 3 hours and successfully removed it. Blood transfusions were required and, at times, it appeared that he would not make it off the table. This morning he is alert, awake and smiling and tomorrow should resume taking solid food. This will probably be the signature case of the trip but in reality his future depends on his getting to Dar es Salaam for follow-up chemotherapy and radiation. Otherwise he is not likely to survive past 1-2 years. Today, after the C-sections cleared out we managed to do 3 interesting cases. The first was a woman who had been assaulted in a local village because she was suspected of being a witch. Someone took a heavy stick to her head and caused a depressed skull fracture and a skin wound so severe that a piece of her skull the size of a sliver dollar was bared to the bone. It took some fancy plastic surgery techniques to get the bone covered. We have no facility for dealing with the fracture but so far she shows no signs of brain damage. The next case was the removal of a softball size benign fatty tumor from the front of a woman’s leg. We wound up the day by removing a large testicular tumor from a middle aged man. Ara and I then decided it was “Kili Time”, named for our favorite beer, Kilimanjaro. An adequate but by now boring dinner followed 2 games of scrabble. Ara leads 4 games to 2 and all have been well played. And so here I sit, writing this post before I have to give the computer back to Ara so he can continue his French lessons. Tomorrow is a straight clinic day though we may get to do one case in the afternoon. Sitting in the office is not my favorite. As Ara put it, “Surgery is the game, clinic is the penalty box.” Spoken like a true surgeon.

Comments

[Buy Online Rx]

I agree. The old favourites never fail me when I'm restless or just can't settle or have just read a terrific book & nothing else seems right as the next read. Rereading can be blissful.

[mens health]

Perry hasn't refused to debate Bill White, that is a lie. What Perry has done is say he won't debate till Bill White stops refusing to release his taxes.

[Rachel Irwin]

Would the photo of the boy with the Wilms tumor be available in high resolution for publishing in a nursing textbook?