Gobble gobble,
I am alone. The last Thursday in November and I am alone. Sarah left Tuesday to stay in an Arab village for a few days.
She made friends with a tiny Arab girl whose mother was hospitalized, pregnant, and with malaria. They are cattle herder nomads. Another member of their clan was diagnosed with AIDS and tuberculosis and had just finished his first two months of treatment in the hospital. He came in with draining tuberculous lymph nodes on his neck and was all skin and bones with no hair. Although a strong Muslim he insisted on joining us for "prayer" several evenings and was interested very much in the one true God who also loved him. So, Mahamat (as he is called), came to escort Sarah to his "village". I was to be without a wife for at least 3-4 days. She wasn't sure when she'd be back.
One of my biggest fears about being married was how I was going to sleep with someone else in the bed with me. About the only time in my life I'd ever shared a bed with someone was during family vacations when I was a child. My twin brother, David, and I had to often sleep in the same double bed and we spent most of the nights fighting for covers or sleeping fitfully in the cold. As a result, I was convinced I could never sleep well with someone else always wanting the blankets or kicking me or rolling over on me or pushing me to the edge of the bed. But, now I find that I have a hard time sleeping without Sarah there.
So I toss and turn all night and find myself awake and alone at 6:30 am on the last Thursday of November. The phone rings.
"Hallo"
"Oui, bonjour, c'est André, �a va?"
"Oui, �a va..."
"Vous allez f�ter ce soir?"
And it all comes back to me, today is Thanksgiving. André had also left me alone on Wednesday to take care of some money issues with the PASS project and for some reason calls me to ask me if we're celebrating this evening.
I'd forgotten. Now I feel even more alone as my family is so far away and one should be with one's family on Thanksgiving.
I go next door and ask Nellie and Rebecca if they would like to fix a dinner and invite the hospital staff to dine with us for Thanksgiving. They agree. We ask Salomon to buy three chickens and I go to the hospital.
It's André who's supposed to read the daily Bible chapter for staff worship. I take his place. At the end, as is our custom, we ask for prayer requests. I take the opportunity to thank God for Thanksgiving and to invite them all to have dinner with us at 5 pm. I say I'll talk more about it later, but they're all invited. As we discuss the cases from the evening, Thanksgiving slips my mind.
The day is thankfully slow. I had planned to do an open reduction and internal fixation of a mandible fracture but the girl never shows up. She had been hit with a stick in the jaw by her husband. By the time she went to the hospital in Lai, was referred to us, was sent by us to Kélo for an xray, returned the one day I was sick and so went to the traditional healer, came back with the xrays but not the patient, and finally returned...three weeks have passed. I hope she'll show up tomorrow.
Other than that, it's a routine day of rounds, clinic and minor procedures. I'm actually able to leave at 3 pm as scheduled. Nellie, Rebecca and I start to prepare Thanksgiving dinner.
I boil water and dump in half a can of mashed potato flakes...voila! an essential Thanksgiving dish! The gravy is made my Rebecca who unfortunately has no other oil but the local peanut brand...it tastes like peanut butter. We have a can and a half of green beans, a can of cranberry sauce, two cans of baked beans, Rebecca makes stuffing from Salomon's bread, Salomon boils the chickens in tomato sauce to be served over rice and we are set.
I set out the plastic chairs that came in the container out in the courtyard along with our two locally made couches. The sun is going down turning everything a glowing orange. Samedi is the first to arrive and the only one on time. Soon after Pierre and David show up. Then a cry arises from the street. I look up.
"Sarah! Sarah! Sarah!" The kids are screaming.
Next thing I know around the corner of the hospital comes a wild haired red head bouncing on a fine Arab stallion with dust on her face pierced by the widest smile imaginable. Behind her comes a robed and turbaned Arab on a donkey with a sheep tied behind his saddle. My joy is complete. I didn't expect her till tomorrow. As she swings down from the saddle I stride over to meet her and sweep her up in my arms. I can tell the trip has been good for her. She looks dirty but refreshed.
As the sun goes down most of the staff have arrived. Samedi and Anatole have been regaling us with stories from the hospital's past and all the missionaries of B�r� past. Degaulle insists on singing one of the only two songs he knows in English: "She'll be comin' 'round da mountain when she comes..." At least he thinks he's speaking English. I join in.
Everyone chows down and the food disappears fast. Even the team on duty breaks away for a few minutes to partake. The two Arabs accompanying Sarah (Mahamat and his father), also join in.
At the end, everyone goes around saying what they're thankful for. As usual, Degaulle flies off on a tangent and we all try to gently (and finally, roughly) to bring him back to the point. Anatole surprises me by being so thankful that God brought him to B�r� because his life has been saved and so much bettered by having been here. I am shocked as all he usually does is complain about things. Even Mahamat is thankful that his sickness brought him to B�r� where his "eyes were opened" and his body was cured. I, of course, am thankful that in the last year God found me a hot Danish nurse for a wife...even way out in Tchad.
Lazare says something bizarre, as usual, but says it with such enthusiasm and obvious joy that everyone bursts out in applause at the end. Finally, they all leave except Lona's two sons, Fambé and Henri, who spontaneously help bring in the two couches even though they are only 3 and 5 years old respectively.
While the generator is still on I show Sarah half of the best Thanksgiving movie ever, "Planes, Trains and Automobiles". Then the generator cuts off and we go back to our rooms in darkness.
All day I'd been trying to call my family to wish them a Happy Thanksgiving but the satellite phone wasn't connecting. Finally, late that night I get through just as they are finishing eating waiting for the apple pie to come out of the oven. Grandpa, Grandma, Aunt Jeannette, Mom, Dad, and Chelsey are all there. While I'm jealous of the apple pie and the family being together, I have to admit my Thanksgiving has been hard to beat!
Sunday, November 27, 2005
Thursday, November 17, 2005
N'Djamena police chase
It was during my first month in Chad. I was stuck in N'Djam�na, trying to get a long term visa without knowing French, without knowing which offices to go to, without knowing whose signatures and stamps to get (and in which order!), and especially without knowing my way around.....
.....For almost two weeks I have just waited. A pastor and his wife have taken me into their home, assuming that it would only be a few days before I can go out to B�r� hospital and finally start learning the languages and to work. But my tourist visa only lasts for one month. A government official has promised to help me, but then an important journey came up and he had to leave.
Concerning the language, I do wonder what in the world I was thinking (or rather, not thinking) in going to a place by myself, where I don't know the languages or anybody. But in His mercy, God has come to my rescue: The pastor and his wife are from Brazil and speak Portuguese. Not that I do, but it somewhat reminds me of Spanish that I learned a bit of while 6 months in Peru, two years earlier. So they speak Portuguese to me, and I answer in Spanish. And dread the day I will end up in B�r�, with only French, Arabic and the local dialect to choose from.
Each day I go with the pastor's wife to the school where she is teaching. I sit 5 hours in the nearby church and read and go back home with her afterwards. I go to bed early, and am woken up every morning at 4 am by the minaret nearby loudly praising Allah and inviting to Morning Prayer. I find it hard to want to praise anybody, brutally being wakened up like that at the only time of day when it's actually cool enough to get some rest!
At last the government official is back. He has something for me to do while still waiting for the visa: there's a clinic near the main market and the big mosque. There is a dentist, and I can go help him pull teeth. The first day the pastor's wife shows me which minivan to squeeze into, and where to get off. She explains to me how to get back, too. So instead of going with her in the mornings, I now go to the clinic. I bring my dictionary and spend most of the time trying to learn more French.
The dentist has a cup that the patients sip from in between his twisting and pulling their teeth. Blood runs off its sides, along with saliva and rotten stumps of teeth. I hardly believe my own eyes when the first patient is done and another quickly takes his place in the chair. And sips from the same cup, not noticing it's only half full (since it has not been changed out or even emptied or cleaned after the first patient.) I am so perplexed and lacking words (of course), I mostly just feel like pointing to the bloody, slimy cup and screaming!!
The dentist likes to talk. Especially about the terrible situation his country is in, with both tuberculosis and AIDS all over. While he talks, I come up with something to say. Somehow I get the words together and ask: "What would happen, if a patient with, for example, AIDS or tuberculosis comes in here, drinks from the cup and bleeds on it, and then right after that someone else comes in and drinks from the bloody cup again?" He answers right away that it would not be good. Next day he has bought a couple of new cups that once in a while get dipped in a bucket with soap water.
The government official arrives at the clinic to tell me he needs two pass port photos from me, and then the visa can be issued. Thrilled, I ask the dentist where to get photos taken. He explains which minivan to get on, and when I see a certain shop on my right hand, then to ask to be dropped off. I go to the big public bus stop, near the main mosque. I get in, and as usual we have to wait to go till the bus is full. Because of the heat, the side door is still open, and I sit right next to it to get most possible of a possible breeze. Someone has opened the back door to load stuff, when suddenly the driver jumps in behind the wheel and takes off! While pressing the horn and pushing the speeder he gets everyone to jump to the side and other vehicles to leave him space on the road. The back door is still open, and I hold on to the frame of the car to not fall out the open side door! "Geez", I think," that's so rare to see anyone here in a hurry!" I want to close the door, but the driver does not slow down over the uneven and bumpy road, so I can't let go of my grip. I get a feeling he's not just in a hurry. I look back and see a jeep filled with armed military in the back, trying hard to catch up with us!
Turning to the front window, I see how the driver takes a narrow street to the left. I'm sure the chase will soon be over, because the street is packed with people selling their vegetables, chickens or other goods at both sides of the street, and I can't believe the driver will run over someone on purpose. Well, he doesn't, but people have to jump for their lives! Women with heavy baskets on their heads throw everything to jump to security; others push people in front of them to not get run over. The driver turns another corner without looking to his sides, speeds up, and tries another little ally. I try to figure out how to fold my arms around my head, so when we do drive into another vehicle I won't break my neck! But we are all bouncing around inside the car and have to hold on to whatever is closest.
Finally the driver ends up in a big area with other minibuses, and before the bus has come to stop he's out and running towards a market set up of several tents. Everybody else gets out of the minibus as fast as possible and are soon scattered. I guess this ride was for free! But I find myself in this unknown market, surrounded by Arabic speaking businessmen and heavily veiled women that all look down and hurry in whatever direction they are headed. I look around. I don't even know the name of the place I was going, just to get off when I see a certain shop on the right. I have lost all sense of direction, and nobody understands anything I say. Not that I actually try to get the attention of the Arab men, who, in my experience, could easily misunderstand my "interest" in them.
I have looked around for a while. I see people get into smaller taxies, and I recognize a lady who was also in the minibus. I get in the same taxi. I don't even ask where we are going. After all, how can this turn out to be a greater adventure than the previous?
Sarah
.....For almost two weeks I have just waited. A pastor and his wife have taken me into their home, assuming that it would only be a few days before I can go out to B�r� hospital and finally start learning the languages and to work. But my tourist visa only lasts for one month. A government official has promised to help me, but then an important journey came up and he had to leave.
Concerning the language, I do wonder what in the world I was thinking (or rather, not thinking) in going to a place by myself, where I don't know the languages or anybody. But in His mercy, God has come to my rescue: The pastor and his wife are from Brazil and speak Portuguese. Not that I do, but it somewhat reminds me of Spanish that I learned a bit of while 6 months in Peru, two years earlier. So they speak Portuguese to me, and I answer in Spanish. And dread the day I will end up in B�r�, with only French, Arabic and the local dialect to choose from.
Each day I go with the pastor's wife to the school where she is teaching. I sit 5 hours in the nearby church and read and go back home with her afterwards. I go to bed early, and am woken up every morning at 4 am by the minaret nearby loudly praising Allah and inviting to Morning Prayer. I find it hard to want to praise anybody, brutally being wakened up like that at the only time of day when it's actually cool enough to get some rest!
At last the government official is back. He has something for me to do while still waiting for the visa: there's a clinic near the main market and the big mosque. There is a dentist, and I can go help him pull teeth. The first day the pastor's wife shows me which minivan to squeeze into, and where to get off. She explains to me how to get back, too. So instead of going with her in the mornings, I now go to the clinic. I bring my dictionary and spend most of the time trying to learn more French.
The dentist has a cup that the patients sip from in between his twisting and pulling their teeth. Blood runs off its sides, along with saliva and rotten stumps of teeth. I hardly believe my own eyes when the first patient is done and another quickly takes his place in the chair. And sips from the same cup, not noticing it's only half full (since it has not been changed out or even emptied or cleaned after the first patient.) I am so perplexed and lacking words (of course), I mostly just feel like pointing to the bloody, slimy cup and screaming!!
The dentist likes to talk. Especially about the terrible situation his country is in, with both tuberculosis and AIDS all over. While he talks, I come up with something to say. Somehow I get the words together and ask: "What would happen, if a patient with, for example, AIDS or tuberculosis comes in here, drinks from the cup and bleeds on it, and then right after that someone else comes in and drinks from the bloody cup again?" He answers right away that it would not be good. Next day he has bought a couple of new cups that once in a while get dipped in a bucket with soap water.
The government official arrives at the clinic to tell me he needs two pass port photos from me, and then the visa can be issued. Thrilled, I ask the dentist where to get photos taken. He explains which minivan to get on, and when I see a certain shop on my right hand, then to ask to be dropped off. I go to the big public bus stop, near the main mosque. I get in, and as usual we have to wait to go till the bus is full. Because of the heat, the side door is still open, and I sit right next to it to get most possible of a possible breeze. Someone has opened the back door to load stuff, when suddenly the driver jumps in behind the wheel and takes off! While pressing the horn and pushing the speeder he gets everyone to jump to the side and other vehicles to leave him space on the road. The back door is still open, and I hold on to the frame of the car to not fall out the open side door! "Geez", I think," that's so rare to see anyone here in a hurry!" I want to close the door, but the driver does not slow down over the uneven and bumpy road, so I can't let go of my grip. I get a feeling he's not just in a hurry. I look back and see a jeep filled with armed military in the back, trying hard to catch up with us!
Turning to the front window, I see how the driver takes a narrow street to the left. I'm sure the chase will soon be over, because the street is packed with people selling their vegetables, chickens or other goods at both sides of the street, and I can't believe the driver will run over someone on purpose. Well, he doesn't, but people have to jump for their lives! Women with heavy baskets on their heads throw everything to jump to security; others push people in front of them to not get run over. The driver turns another corner without looking to his sides, speeds up, and tries another little ally. I try to figure out how to fold my arms around my head, so when we do drive into another vehicle I won't break my neck! But we are all bouncing around inside the car and have to hold on to whatever is closest.
Finally the driver ends up in a big area with other minibuses, and before the bus has come to stop he's out and running towards a market set up of several tents. Everybody else gets out of the minibus as fast as possible and are soon scattered. I guess this ride was for free! But I find myself in this unknown market, surrounded by Arabic speaking businessmen and heavily veiled women that all look down and hurry in whatever direction they are headed. I look around. I don't even know the name of the place I was going, just to get off when I see a certain shop on the right. I have lost all sense of direction, and nobody understands anything I say. Not that I actually try to get the attention of the Arab men, who, in my experience, could easily misunderstand my "interest" in them.
I have looked around for a while. I see people get into smaller taxies, and I recognize a lady who was also in the minibus. I get in the same taxi. I don't even ask where we are going. After all, how can this turn out to be a greater adventure than the previous?
Sarah
Wednesday, November 2, 2005
Miscellaneous experiences...
Friends,
Random experiences:
1. The baby has one normal leg. He is two days old brought in by his arab nomad parents. The second leg is cut off halfway up the shin with something like a floppy foot with toes with no bones. Oh, he also doesn't have an anus which is why he was brought in. We take him to the OR, an IV started by Samedi sticking out from his good foot. Sarah administers the Ketamine anesthetic and the baby sleeps. I know I will have to do one of two things--one easy and the other hard. The most difficult will be to open his stomach, find his colon, cut a hole in it, attach it to his abdominal wall and let him poop out of there until his is old enough to try and create an anus for him. The easiest is what I try first. I heard about this a few weeks ago when I was with my surgeon friend, Greg Shank, at Koza Hospital in northern Cameroon. I grab a needle and a syringe and I poke it into his butt skin where his anus should be. I aspirate and fortunately, about 2cm in I hit meconium (baby's first poop). I leave the needle in to guide me and slice through his skin. I grab a clamp and dissect down until I pop into his rectum where black meconium and brown, stinky, regular poop pours out. I leave a piece of rubber catheter in and he wakes up to a new experience...defecation!
2. Angeline is well known at the hospital. She came in last year with osteomyelitis and ended up having to have the middle part of her left tibia taken out and her wound dressed with diluted Chlorox in order to get rid of the infection. Of course, that took months. We saw her grow up (and fatten up) before our eyes. She was always wary of us, though, and would often cry just seeing Sarah or I. Unfortunately, her bone never reformed and she was left with a floppy left lower leg that was left in a cast. When my orthopedic surgeon friend, Troy Dickson, was here we tried to contact her to come and have some sort of transplant procedure. We couldn't find her, however, so Troy told me what to do and left. Now she is before me.
Her leg is still floppy but the joints are also still moving normally and the fibula is intact. She is fat and healthy and yes looks at me with suspicion. I decide that her only chance of walking again is to do what Troy suggested and I've read about but never seen: a fibula transplant.
Sarah puts Angeline to sleep. Both legs have been scrubbed and now prepped with Betadine. My heart is in my throat. I know I'm in way over my head. I scrub and drape. I grab the scalpel and cut into the lateral side of her good leg and down to her fibula. I'd measured the defect on xray to be 7cm. I separated the middle part of the fibula from its attachments to the tibia and then with a tiny, Swiss Army Knike-like saw I cut out her tiny, chicken bone-like fibula. I put it in a dish of saline, close the defect in layers, staple her skin shut and cover it with a sterile dressing.
I go to the other side of the table and cut into her old scar and down to the two stubs of bone. I clean them up by munching on the ends of them with an instrument called a Rongeur, pull out some of the spongy bone from the knee end of the tibia, pull out the fibula and find it too short.
I split it in half and jam it into the two ends of tibia and surround the three fracture sites with pieces of spongy tibia. I close the fascia over the graft and staple the skin shut. I put on a dressing and a fiberglass cast with her leg in as close to normal position as I can guess without access to intraoperative x-ray.
I take off my gloves and gown, Angeline wakes up and my heart finally descends to its normal place in my chest. It was thanks to last year's SM, Jennie Norton, that her surgery is paid for but it will be only through supernatural intervention that it will actually heal and allow her to walk.
3. The baby has what sounds like asthma on listening with the stethescope, but as Dr. Ken points out, the baby's only one month old so it's probably bronchiolitis. In either case the only thing to do is treat with nebulized albuterol and oxygen. We have albuterol but no oxygen...wait, didn't we get one in the container? We search in our storehouse and find the oxygen extractor which we've never tried. Micky, the visiting ER nurse, is administering the neb. The lights are on because the sun has just gone down and our 2 hours of programmed electricity is just beginning so we find a transformer and plug in the O2 extractor. It works and the baby seems to be doing well on it as we watch its oxygen saturation rise (on the O2 sat machine given us 3 years ago by Erling Oksenholt the night I visited him in Oregon on the spur of the moment before going to Chad to visit for the second time on a trip that lasted only 2 days and didn't include a visit to B�r�). It started at 85% and is now up to 93-95%.
I'm called to see a 12-year-old boy with a swollen stomach and no stool or gas for a day. He needs a laparotomy. We go to the OR. His thin body is in contrast to his firm, bloated belly. Sarah finds an IV fast and gives him his Ketamine. I scrub and drape and quickly cut him open from sternum to pelvis around his belly button as his intestines pop out and spill across the abdomen. I don't see anything obvious at first but there are red patches all over the intestines with little darker areas. Something is weird. I think maybe Typhoid fever at first at the point of perforating.
Then, as I run the intestines I discover that part of it has twisted on itself. I untwist it and quickly the dark areas become normal covered except for those patches that look almost dead. I know I can't leave them.
I put on bowel clamps, clamp and cut through the mesentery on the bad looking section and once all the blood vessels are tied off I cut the dead intestine out and then suture the two cut ends back together in two layers of running sutures. I release the clamps, there is no leakage. I leave in a drain and close the fascia with sutures and the skin with staples.
I go back to check on the one month old. I see a dead bat in the trash can by the door. The nurses look up mischievously. The baby is stable but still wheezing. Apparently, a bat entered the room, hit the fan, and landed directly on the baby's face, dead as a doornail! The baby lives through the night and the next day and the next and goes home the third day.
The boy recovers normally and by the 5th day post op is eating, walking, pooping, and passing gas. He goes home, comes back 3 days later to have his staples out and looks fine.
4. The baby is one month old and has a circular wound around the back of its head. Over the course of the next few days of antibiotics and dressing changes the whole part of his scalp that is inside the circle comes off leaving his skull exposed in the center. We continue antibiotics, he nurses normally and to all other appearances is totally healthy. We do dressings with diluted Chlorox and his wound starts to turn beefy red. He is still hospitalized.
5. A 1 1/2-year-old comes in. She'd been seen by me in April 2004 when she was a few months old and had an abscess on her left arm incised. Apparently she did well and I never saw her again until today. Now she has a bone sticking out of her forearm. It is jagged and rotten. Her hand and arm move and function normally. A centimeter from the bone is another wound draining pus. The radius and ulna appear intact but there's this third bone sticking out. It seems her bone got infected last year but since she's so young and otherwise healthy a new bone formed pushing the infected part out until it came out the skin. Sarah gives her an IM shot of Ketamine and I grab the bone with a clamp and pull out a 3 cm long piece! That's it. She comes back two days later and the two wounds are all but closed and her hand and arm continue to function normally...
6. Today, a woman comes in with a change in bowel habits and a big hard mass right under her sternum that is pulsating. I can only think of very bad things that I couldn't do anything about like cancers and aneurysms and such. I say she should go to N'Djam�na. The husband says he doesn't have the money. I say maybe and x-ray would help, but our machine is down one week after our friends from Florida got it up and running. Finally, I say we can try and ultrasound but I don't think I'll be able to see much.
I pull out the portable, laptop-sized ultrasound just donated by GE and brought by the Florida team. It runs on batteries, so I can use it without the generator. I turn it on, put in her name and place the probe over the mass. To my pleasant surprise, it appears that it is in her liver and that it is either a cyst or an abscess. After looking in some books I am convinced that it is an amebic liver abscess so I hospitalize her and put her on Metronidazole. I will be able to check on her in a few days again and see if it's going down in size. If not I can use the ultrasound to help me put a needle in it! Technology comes to B�r�! Above all, I thank God that He made me think to use the ultrasound. Sometimes, I am so used to hopeless situations that it's hard to get used to having more options around now.
James
Random experiences:
1. The baby has one normal leg. He is two days old brought in by his arab nomad parents. The second leg is cut off halfway up the shin with something like a floppy foot with toes with no bones. Oh, he also doesn't have an anus which is why he was brought in. We take him to the OR, an IV started by Samedi sticking out from his good foot. Sarah administers the Ketamine anesthetic and the baby sleeps. I know I will have to do one of two things--one easy and the other hard. The most difficult will be to open his stomach, find his colon, cut a hole in it, attach it to his abdominal wall and let him poop out of there until his is old enough to try and create an anus for him. The easiest is what I try first. I heard about this a few weeks ago when I was with my surgeon friend, Greg Shank, at Koza Hospital in northern Cameroon. I grab a needle and a syringe and I poke it into his butt skin where his anus should be. I aspirate and fortunately, about 2cm in I hit meconium (baby's first poop). I leave the needle in to guide me and slice through his skin. I grab a clamp and dissect down until I pop into his rectum where black meconium and brown, stinky, regular poop pours out. I leave a piece of rubber catheter in and he wakes up to a new experience...defecation!
2. Angeline is well known at the hospital. She came in last year with osteomyelitis and ended up having to have the middle part of her left tibia taken out and her wound dressed with diluted Chlorox in order to get rid of the infection. Of course, that took months. We saw her grow up (and fatten up) before our eyes. She was always wary of us, though, and would often cry just seeing Sarah or I. Unfortunately, her bone never reformed and she was left with a floppy left lower leg that was left in a cast. When my orthopedic surgeon friend, Troy Dickson, was here we tried to contact her to come and have some sort of transplant procedure. We couldn't find her, however, so Troy told me what to do and left. Now she is before me.
Her leg is still floppy but the joints are also still moving normally and the fibula is intact. She is fat and healthy and yes looks at me with suspicion. I decide that her only chance of walking again is to do what Troy suggested and I've read about but never seen: a fibula transplant.
Sarah puts Angeline to sleep. Both legs have been scrubbed and now prepped with Betadine. My heart is in my throat. I know I'm in way over my head. I scrub and drape. I grab the scalpel and cut into the lateral side of her good leg and down to her fibula. I'd measured the defect on xray to be 7cm. I separated the middle part of the fibula from its attachments to the tibia and then with a tiny, Swiss Army Knike-like saw I cut out her tiny, chicken bone-like fibula. I put it in a dish of saline, close the defect in layers, staple her skin shut and cover it with a sterile dressing.
I go to the other side of the table and cut into her old scar and down to the two stubs of bone. I clean them up by munching on the ends of them with an instrument called a Rongeur, pull out some of the spongy bone from the knee end of the tibia, pull out the fibula and find it too short.
I split it in half and jam it into the two ends of tibia and surround the three fracture sites with pieces of spongy tibia. I close the fascia over the graft and staple the skin shut. I put on a dressing and a fiberglass cast with her leg in as close to normal position as I can guess without access to intraoperative x-ray.
I take off my gloves and gown, Angeline wakes up and my heart finally descends to its normal place in my chest. It was thanks to last year's SM, Jennie Norton, that her surgery is paid for but it will be only through supernatural intervention that it will actually heal and allow her to walk.
3. The baby has what sounds like asthma on listening with the stethescope, but as Dr. Ken points out, the baby's only one month old so it's probably bronchiolitis. In either case the only thing to do is treat with nebulized albuterol and oxygen. We have albuterol but no oxygen...wait, didn't we get one in the container? We search in our storehouse and find the oxygen extractor which we've never tried. Micky, the visiting ER nurse, is administering the neb. The lights are on because the sun has just gone down and our 2 hours of programmed electricity is just beginning so we find a transformer and plug in the O2 extractor. It works and the baby seems to be doing well on it as we watch its oxygen saturation rise (on the O2 sat machine given us 3 years ago by Erling Oksenholt the night I visited him in Oregon on the spur of the moment before going to Chad to visit for the second time on a trip that lasted only 2 days and didn't include a visit to B�r�). It started at 85% and is now up to 93-95%.
I'm called to see a 12-year-old boy with a swollen stomach and no stool or gas for a day. He needs a laparotomy. We go to the OR. His thin body is in contrast to his firm, bloated belly. Sarah finds an IV fast and gives him his Ketamine. I scrub and drape and quickly cut him open from sternum to pelvis around his belly button as his intestines pop out and spill across the abdomen. I don't see anything obvious at first but there are red patches all over the intestines with little darker areas. Something is weird. I think maybe Typhoid fever at first at the point of perforating.
Then, as I run the intestines I discover that part of it has twisted on itself. I untwist it and quickly the dark areas become normal covered except for those patches that look almost dead. I know I can't leave them.
I put on bowel clamps, clamp and cut through the mesentery on the bad looking section and once all the blood vessels are tied off I cut the dead intestine out and then suture the two cut ends back together in two layers of running sutures. I release the clamps, there is no leakage. I leave in a drain and close the fascia with sutures and the skin with staples.
I go back to check on the one month old. I see a dead bat in the trash can by the door. The nurses look up mischievously. The baby is stable but still wheezing. Apparently, a bat entered the room, hit the fan, and landed directly on the baby's face, dead as a doornail! The baby lives through the night and the next day and the next and goes home the third day.
The boy recovers normally and by the 5th day post op is eating, walking, pooping, and passing gas. He goes home, comes back 3 days later to have his staples out and looks fine.
4. The baby is one month old and has a circular wound around the back of its head. Over the course of the next few days of antibiotics and dressing changes the whole part of his scalp that is inside the circle comes off leaving his skull exposed in the center. We continue antibiotics, he nurses normally and to all other appearances is totally healthy. We do dressings with diluted Chlorox and his wound starts to turn beefy red. He is still hospitalized.
5. A 1 1/2-year-old comes in. She'd been seen by me in April 2004 when she was a few months old and had an abscess on her left arm incised. Apparently she did well and I never saw her again until today. Now she has a bone sticking out of her forearm. It is jagged and rotten. Her hand and arm move and function normally. A centimeter from the bone is another wound draining pus. The radius and ulna appear intact but there's this third bone sticking out. It seems her bone got infected last year but since she's so young and otherwise healthy a new bone formed pushing the infected part out until it came out the skin. Sarah gives her an IM shot of Ketamine and I grab the bone with a clamp and pull out a 3 cm long piece! That's it. She comes back two days later and the two wounds are all but closed and her hand and arm continue to function normally...
6. Today, a woman comes in with a change in bowel habits and a big hard mass right under her sternum that is pulsating. I can only think of very bad things that I couldn't do anything about like cancers and aneurysms and such. I say she should go to N'Djam�na. The husband says he doesn't have the money. I say maybe and x-ray would help, but our machine is down one week after our friends from Florida got it up and running. Finally, I say we can try and ultrasound but I don't think I'll be able to see much.
I pull out the portable, laptop-sized ultrasound just donated by GE and brought by the Florida team. It runs on batteries, so I can use it without the generator. I turn it on, put in her name and place the probe over the mass. To my pleasant surprise, it appears that it is in her liver and that it is either a cyst or an abscess. After looking in some books I am convinced that it is an amebic liver abscess so I hospitalize her and put her on Metronidazole. I will be able to check on her in a few days again and see if it's going down in size. If not I can use the ultrasound to help me put a needle in it! Technology comes to B�r�! Above all, I thank God that He made me think to use the ultrasound. Sometimes, I am so used to hopeless situations that it's hard to get used to having more options around now.
James
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