I'm lying on the floor. It's my back again. After a long day as a tall person in world made for short people the only relief I get is stretching out on the cold cement floor. Our newest little companion, Garfield, is lying on my chest purring contentedly. He's finally stopped whining and meowing now that he feels he's the center of my attention.
I'm waiting for them to call me from the hospital. A young man previously operated on in April 2006 is back with a swollen tender belly...all the signs of intestinal obstruction. I fill out the OR sheet and send the family to the Pharmacy. They say they need to wait for the boy's father. So I finish the rest of my work and come home. Koumabas, the pharmacist, comes in the late afternoon to say the father has come but he's not sure he wants the operation. I walk over there and call the father into my office. He says his son has been operated on already two times, he's not sure about this time. Besides, he says it's too expensive. I look at what has been calculated for the surgery, anesthesia, hospitalization and post-op care: $145. It seems a bit steep to me too. I have Koumabas recalculate. We have two different payment scales. If the patient is in our health district they pay half of what the others pay. It seems, they didn't know he was from Bere. We recalculate: $110. He seems more agreeable and says he'll sell some bags of peanuts in the market tomorrow and pay us if we can wait.
I explain to him that it's urgent, his son needs an operation yesterday. He says he has a motorcycle, but his "brother" took it to the market. I tell Koumabas that when he comes back he should fill out the forms, call the OR team and when the patient is ready have them come and get me.
So, I'm lying with a kitten on my lap on a cool cement floor waiting. A knock comes on the door.
"Hey, it's Cory, we're having worship at our house later on."
"What time is it?"
"Ok, in half an hour or so?"
I get up and straighten up the house and do the dishes. 7:00pm comes and still no call from the hospital. I go over to Cory's. After half an hour or so of beating on a drum, mostly in rhythm with Philip's guitar playing, I figure I better go find out what's going on. As I go outside, I see our original cat, Erling, waiting for me. He follows me to the gate but is impatient and jumps up the wall and through the chain link while I fiddle with the padlock. He rolls around in the grass begging for some attention. I pet him for a few seconds, but have more important things to do. I find Koumabas.
"Salut, ca va? What's up with the OR case?"
"Abel and Enock came, but Simeon is out 20km away in his rice field so they went home to wait for Simeon. I tried to call Samedi, his phone is shut off."
I go to see the young man.
"Have you pooped? Farted?"
"Ok, come with me."
He slowly gets up and shuffles behind me, his nasogastric tube hanging limply from his right nostril without any collection bag attached, just a little green, bilious fluid resting in the curve of the tube.
I open the OR and place him on a gurney. The generator is already on so I flip on the A/C in the OR so it can cool down from the day's heat and grab an IV catheter, some IV tubing, a bottle of normal saline and a bottle of Metronidazole.
I turn on the dental light adapted as a minor procedure light in the prep room, attach a tourniquet and am pleased to see many nice fat veins pop up on our young patient's arm. I see a monstrous one in the depression on the opposite side of his elbow and figure I'll go for that since there's no way I can miss it. I blow it. I undo the tourniquet, have the youth hold pressure with cotton and find another catheter. I put the tourniquet back on and this time nail a much smaller vein.
As I'm preparing to put in the urine catheter, Samedi shows up followed shortly thereafter by Enock and Abel. Just as I'm getting ready to do the spinal, Simeon arrives and I begin to breath easier now that we have a full OR team. Samedi and Abel scrub and prepare the instruments. I scrub and we drape the patient after Enoch has slathered him in Betadine. After prayer, I decide to start in his lower abdomen. I follow the old scar from his pelvis to his belly button. Swollen small bowel wants to burst out. Many sections are stuck to the abdominal wall and everything is swollen and oozes easily. We are mopping up inflammatory fluid and blood which obscures the surgical field as I try to dissect the small bowel off the abdominal wall so I can open the rest of the belly.
Finally, I'm able to start running the bowel and I find a section that had been cut off by adhesions from the previous surgery and there's a small necrotic section. I try and free up the adhesion but it's impossible. I clamp it off and take out the bad section. I then call for a sterile basin and open up the end of the bowel that is distended. Liquid stool and gas almost explodes out. Samedi and I find the most proximal part possible and with our fingers gently squeeze the stool and gas towards where the bowel is open until we've cleared out almost three liters of watery stool. I clamp the bowel again, Enock takes the basin off the field, we irrigate and place the intestines back in the abdomen. I get a fresh lap sponge under the cut section of intestine and slowly suture it back together in two layers.
We irrigate again with several liters of fluid, place two drains and close the fascia leaving the skin open. I'm exhausted and slip to the OR floor resting against the wall as the others clean up. I then help them transfer the patient to the gurney, turn off the A/C, water pump and OR lights before switching off the generator, and head home.
Erling is waiting for me and I give him the love he deserves before heading home, the cat scampering ahead and then waiting for me until we get to the house. He slips in and then meows as I go inside to get him some peanut clusters. Erling is afraid of Garfield and our other cat Chir, so he stays on the porch crunching happily on his dried peanut paste. I take a shower and then stretch out on the floor again to ease my aching back.
Garfield comes gingerly over, meowing plaintively. I grab him around the chest and place him on my stomach. He curls up contentedly and starts purring as his eyes open and close as only happy cats do.
06 November 2010
Posted by jj at 1:59 PM