Putting the general back in surgery

Today was another whirlwind day at Soddo Christian Hospital.  John and I stayed up late organizing our patient list to make morning rounds more efficient.  It's been a few months since I had to manage 34 inpatients at once plus handle a full operative schedule.  Rounds got interesting right from the start when we didn't recognize the first eight patients.  Why?  Because they were admitted overnight in anticipation of their scheduled operations the next day (no one bothered to inform them).  They included 5 prostatectomies, an Abdominoperineal resection, and Esophagectomy, a 6cm scalp squamous cell carcinoma, and an excision of a recurrent cystic hygroma.  That may not mean much to many of you, but suffice to say that these are not small cases, and only two of them are in my specialty (or lack thereof).  We postponed the esophagectomy, the sqamous cell, and one prostatectomy because we had already booked the schedule with semi-urgent add-ons:  Knee arthrotomies for septic arthritis, excising an infected extremity sarcoma, and doing burn dressing changes under sedation.  In all, I did six (five and a half, really) cases today.  I bailed on the last one (cystic hygroma) 30 minutes in when the power went out and the generator ran out of fuel.  It was getting dark, and I had the anesthesiologist holding a flashlight while I tried to control neck bleeding without suction or cautery.  Thank God I wasn't down to the big vessels yet.  I was able to close and schedule a re-attempt in a day or two.  I hope they get more generator fuel before the next C-section hits.  We're sitting on a lady (not literally) who is three days overdue.  The real obstetrician gets back tomorrow afternoon. 

    The lady from last night's emergency section is doing great, if not a little pale (I didn't mention blood loss, did I?)  Her baby is having some feeding difficulty, though.  Keep him in your prayers - I heard he was doing a bit better this evening.  Oh yeah, we're somewhat responsible for the newborns too.  Please add "neonatologist" and ENT to the hats I'm wearing this week. 

     In spite of the challenges, it is still a rewarding experience.  There's nothing like cramming through the atlas while they prep your patient for something you've never done before.  The real reward, of course, comes if and when the patient does well.  I did a knee arthrotomy for a 15 year old with horrid septic arthritis.  By evening, she was tolerating 90 degree range of motion and her fevers were gone. 

    After work, I did take opportunity to play some pickup soccer.  The OR staff plays just about every evening.  I was quickly reminded that it has been a long time since I really worked out, even longer since I played competitive soccer, and that I have never done either at 7400 feet.  I'm still paying back my oxygen debt.  Tomorrow promises to be another busy day - who knows what unannounce preop patients will be waiting for us.  We have a number of sequestrectomies for osteomyelitis scheduled, we have to wire a jaw shut for a mandibular fracture, and there's that esopagectomy and prostatectomy that we postponed as well.  I'm going to get some rest and pray that all the babies and mommies do as well.