on a good day...

Not gonna lie. Its been a bit rough around here lately. There hasn't been just one major tragedy, but multiple tragedies (big and small) and the every day struggle has been wearing me down. Patients dying, difficult operations, barriers to good patient care...the list could go on. I could write a blog post every day about the continual frustrations of trying to provide good medical care in a resource-limited setting. But then, no one wants to hear about that every day any more than I want to write about it every day. :)

Instead I will write about today. It was a good day. A really good day. Nothing earth-shattering happened...but it was just one of those days that things went well. Here is how it went...

I woke up before my alarm and actually felt rested. While making some tea, I checked online and learned that the Seahawks won the Superbowl. I don't get too excited about football...but I did grow up in Seahawk territory and I'm happy they won. :)  AND...it was cold enough this morning that on my walk to work that I wore my sweatshirt (it got all the way down to 75F last night)!

During morning report, I got a few words of encouragement (its nice to have some positive reinforcement sometimes).

Then, I rushed off to the OR for an emergency C-section for fetal distress. When I opened the abdomen, I saw an amniotic sac with a baby in it...but it wasn't in the uterus. My heart sank. Another dead baby. I took the limp, blue baby out and then... he moved!!! He was alive and started crying! What a happy surprise! A live baby is very rare after uterine rupture.

Between cases, one of the residents asked for help exchanging a gastrostomy (stomach) tube. The patient was a little six year old that had accidentally swallowed some of her mom's cleaning chemicals a couple months ago. The chemical caused her esophagus to scar shut so she can't swallow anything (even her own spit). She was very thin and dehydrated when she was referred to me for placement of a stomach tube.

Little F....she looked like she had gained about 10 pounds! She wouldn't smile or look at me because she was still upset that I had exchanged her tube. 

She will need esophageal replacement surgery, which we cannot do safely here. Hopefully we can find a way to get her to another country to have the operation performed.


Next, I did a washout and closure in a patient who had had a perforated stomach ulcer. Then, my next operation was for a girl in her late teens with a huge abdominal mass (she looked like she was 7 months pregnant). When I saw her in clinic, I couldn't quite tell where the mass was coming from on ultrasound. It definitely wasn't her uterus. Probably not her liver. At the start of the case, I told the team that the case would take one hour or six hours...turned out it took less than thirty minutes! It was a huge ovarian mass that almost literally popped right out. All I had to do was divide the vessels and tubes that attached it to the uterus.

the mass

checking it out

trying to explain where the mass came from in Hausa. its quite difficult since there is no word for "ovary" in Hausa!

When I cut it open I found clumps of hair, chunks of bone, lots of fluid and creamy white sebaceous material. This is good news because it means it was a benign dermoid cyst.

Last case of the day: an inguinal hernia. I am becoming much more proficient at performing inguinal hernia repairs without mesh (not something we do often in America). Now, the tissue based inguinal hernia repair is among my favorite operations here. It was a good way to end the day.


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since you asked... :)

Click on photo to enlarge. This picture is before cutting the mass open. Abby, no colon was harmed  in the taking out of this mass. :) The mass had two different colors probably because she had bled into the red-colored part.

Cut open...

guess that mass

The uterus...its an organ that I didn't operate on much during general surgery residency. It fell under the realm of the gynecologists. In fact, the gynecologists usually took care of anything involving the "female organs" (and, in turn, they would call us for almost anything involving the bowel).

Right now, there are no gynecologists here. Hence, I now operate on the uterus, tubes, and ovaries.  Turns out, as long as you know the anatomy and have an experienced surgeon to consult when things are unusual (as they often are here), its not that complicated.

In addition to the 105 (!) C-sections  I've done so far, I've also removed a few uteri and ovaries. Here are a couple pics:

this was the second elective hysterectomy I've done here (uterus is on bottom right). For reference, the scalpel is 14 cm long (about 5 1/2 inches). I'm not sure what this mass is...but it was big.

This is the inside of a 15cm ovarian cyst that had twisted on itself (torsed). After removing it, I cut it open and found a tooth inside!  Although it seems bizarre, having a tooth growing inside an ovarian mass is a kind of a good thing because it means it was a benign tumor called a dermoid cyst. Those cysts can have anything from hair, teeth, eyes, bone, etc. in them. Fascinating, huh?