I’m writing this on Thursday 8th February – and still haven’t managed to get away from the hospital to post even the last blog! Dr Peter is still ill (apparently bad enough to be in hospital earlier this week – no wonder he didn’t come back last weekend!), so I am still the only surgeon here. Three weeks without a break is becoming quite tiring, more so as the last couple of days I’ve still been operating into the night, having been up working since 7.30am.
I think once Dr Raul is back next Tuesday, I’ll be able to take a couple of days off and get away for a rest. That’s a positive thought to look forward to. I told Dr Rory (in charge) that either I’d get a couple of days off soon, or I’d resign – either way, I’d get a break! I think he realised that I was joking.
I had the strange experience of having my birthday in Uganda on Tuesday of this week. In many ways, it wasn’t too different from back home – often I’ve ended up working on my birthday before. This time I was at least able to control my workload, and finish the day by about 4.30pm. I think most of the other non-surgical docs here are often free by then, but to me it felt very odd! I got a couple of cards from folks here, some food courtesy of someone who was able to get into Kampala that day, and a couple of cards & texts from home.
I had a few folks over for a film in the evening. Not entirely successful…. Thanks to my brother giving me a couple of computer bits to allow me to watch some DVDs he’s put onto a hard drive for me, my main DVD software is not working properly. The options were therefore to use windows media player – but it currently gives full surround sound but no voices at all??? Very strange and not helpful – or playing stuff through winDVD by selecting 30min segments from the file names. That was working well, except that within the same film, the four different segments were in different languages! After the first 20mins I got called to the wards anyway, so it was a bit of a washout. But… once I got back I managed to uninstall and reinstall various drivers, and got the whole thing working again properly. That’s what I call good use of a birthday evening!
The scary responsibility of the title refers to last night’s surgical escapades. Having been operating all day since 10am, at 6.30pm I came out of theatre to review a new paediatric admission who had an obvious bowel obstruction, after a week of bloody diarrhoea. Lots of kids here get their bowel drawn inside itself (an intussusception for the medically minded reader!), and after a while everything turns swollen and necrotic! This was most likely what had happened to this child, although some of the clinical features were not present. In any case this was one sick boy, who was not going to survive without an operation. Unfortunately he was only six months old. I am not, and have never been, a paediatric surgeon, so taking the decision to operate was difficult. Ultimately, the child would have died if I hadn’t operated, so I felt justified taking the risk, even though there was a good chance of it dying in the middle of my operation.
One of the great things about working in theatre’s here is the hospital’s motto – “We treat, Jesus heals”. We usually pray with patients just before they are anaesthetised, and it was great to entrust this little one into God’s hands. During the operation, it rapidly became apparent that most of the large bowel was dead already, and even the small bowel that was left was fairly dodgy. In order to give the best chance I could, I ended up resecting everything, and bringing the bowel to the abdominal surface, emptying it into a bag. If it survived, and recovered, things could then be rejoined to its rectum! After a couple of hours in theatre, the baby was still alive, and I reviewed it on the ward before going to bed. At that point I became a little overwhelmed at the enormity of the responsibility I’m taking on here in Kiwoko for things that I’m not exactly experienced in.
Today was another day. The child is still alive, and doing OK. Praise God! I’ve been operating all day again though – today was another complicated abdomen, and then I took a woman back to theatre who I’d operated on originally at the weekend. A fifty year old lady had been attacked (apparently by her grandson) with a panga – basically a two foot long knife/axe used for chopping through the jungle! She had open fractures of both forearms, and half her face had been chopped off. On Saturday I had cleaned and splinted one arm, amputated the other as the hand had been completely destroyed, and tried to put her face back together – fortunately all soft-tissue problems. She has done remarkably, and the face has healed well.
Today I took her back to finish repairing her forearms which I’d left alone in case of infection. I managed to plate both broken bones – orthopaedics is quite fun really – and although I didn’t manage to get all of the damaged muscles and tendons together again, I think she’ll be left with a useable limb. I also closed the amputation and a couple of other wounds I’d left open. So far so good – but I have no idea what her long-term prognosis will be. Will her family help look after her when she has only one partially useable arm, and significant facial scarring? My heart really went out to her when they brought her in half dead, and I am so glad that we have been able to save her life so far. The theatre and ward staff have been very kind in their appreciation of what I’ve been able to do.
Perhaps my next blog entry will be a little more light-hearted. There’s lots of crazy things go on here, which I’m sure would be amusing to relate!
Steve
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