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. 

First Case - a doozy

    My hopes of making it until Wednesday with no babies did not come to fruition.  We had a relatively stressful, yet uneventful day (meeting 34 inpatients and consulting on 10 or 12 outpatients) and had finished eating dinner with the other missionaries.  We had just changed out of our scrubs (that was our first mistake) when a messenger from the hospital told us we were needed; someone was in labor.  It was a woman we'd seen earlier in the day - due today but without any signs of labor yet.  We find out this evening that she has had eight stillbirths in the past and has walked 15 days from a distant village, timing it so she would get here on her due date.  It was clear she would need a c-section to avoid stillbirth number 9. 

    We booked the case and sent people to round up the anesthetist and OR nurses.  John went to help prep the patient while I ran to the library to grab an old version of Williams' Obstetrics... you know, just to be sure (we were cramming in the surgeons lounge and made sure to note the part where it says not to cut the baby).  Then we just did what we had to do.  It wasn't pretty (really, c-sections are never pretty), but we got that baby out and John patted it on the butt until it started to breathe.  Then we had to control the bleeding (the pictures in the atlas didn't show so much blood).  In the end, the baby, mom, John, and I all made it through the case alive with stable vital signs.  Lori dragged Sarah out of bed (well past her bedtime) and took photos while Sarah awaited the baby in the hall.  When all the dust had settled, we headed back to the house and toasted the last can of Mountain Dew (it's all Crystal Light from here on out) and savored a few precious jalapeno pringles. 

addis ababa and the red jackal

Addis Ababa and the Red Jackal

                We have finally arrived at our final destination after a night's stay in Addis Ababa.   After having my flight out of Milwaukee cancelled (wonderful Wisconsin weather!), the remainder of our travels were smooth.  We made all our connections, our flights were more or less on time, and customs was a breeze.  We met our driver at the Addis airport – the Red Jackal taxi service.  They took us to a mission guest house where we had a hot shower, a good night's rest, and a warm breakfast this morning.  We then went grocery shopping before a 6 hour drive through the Great Rift Valley to Soddo.   

                The landscape here is beautiful…at least once you get out of the choking diesel exhaust of the capital.  Even though it's the dry season, there is plenty of green, even at the tops of the mountains.  We were on roads as high as 10,000 feet which afforded some nice views of the valley.  My ears did more popping on the drive than they did on the flights.  We are at 7,400 feet elevation here. 

                The  hospital compound itself is beautiful and quite well maintained.  Its supplies are meager by Western standards, but as far as mission hospitals, it seems have to developed quite rapidly (it only opened in 2004).  We got a brief tour from Ruth (a GP from the  Netherlands), met some  of the surgical nurses, and confirmed that there were no urgent issues before heading back to our quarters.  We are staying in a house on the grounds which belongs to a "construction missionary" who is currently on leave. 

                We were informed that we are currently the only general surgeons, obstetricians, or orthopedists around at present.  It's a good thing they told me this, because I had no idea I was an obstetrician OR and orthopedist!   Even the Ethiopian surgeons will be away until Tuesday at the earliest and all the residents left this morning.   We were given a list of 18 patients that Dr. Gray (General surgeon who left this morning) had typed up.  It includes everything from burn patients in need of skin grafting to a 3 week old with fevers and a ventriculoperitoneal shunt  (so now I'm a plastic surgeon and a neonatal neurosurgeon too!).   

                Well, it's off to bed soon.  I think I'm over the jet lag, but we'll see in the morning when I actually have to function.  I'm just praying no one feels like giving birth tonight.  I'll be much more ready to play catch come morning.  I'll work on attaching photos later, but our internet connectivity is very poor - uber slow dial-up or bust.  I'll just be happy if I can get this e-mail sent.

-Matt

Layover in Frankfurt

Not too much time to blog here since the internet kiosks are way overpriced here. we had an adventuresome start to things as my flight out of Milwaukee was cancelled. The lady at the ticket counter said, "I suggest you take the bus." To Ethiopia? Wendy and the girls were gracious enough to drive me to Chicago, and all has gone smoothly since then.
I will update again once we are in Soddo, but that will be another day or two. Bye for now.

test e-mail post

This is just a test to see if I can post to the blog via e-mail.  Dr. Gray tells me that blogspot.com is blocked in Ethiopia for some reason.  Someone must have blogged some ill will towards the country at some point.  I should be able to post via e-mail however, and I'm too lazy to set up another blog at this point.  I'll insert a photo (unrelated) to see if that works too.

Bad News

I was just browsing the blogs of the missionaries serving in Soddo. One of them (Harry & Stephne Bowers) just posted news that the market in Soddo caught fire and was completely burnt to the ground. No news of injuries, but many livelihoods have been destroyed. Check out their blog (link to the right) for the photos. I've attached one of them here. So far, I can't find any more details on any news websites.

It's getting closer

I can't believe that it's less than five days before I get on the plane to head to Ethiopia (Milwaukee to Chicago to Frankfurt to Addis Ababa followed by a drive to Soddo). I haven't done much packing, which is only now starting to get me worried. It's nice to know that the climate (and workload) will allow me to pack light for myself. Scrubs and a fleece jacket sounds like all I'll need. I've managed to gather a suitcase of supplies from Holy Family (my hospital in Wisconsin) that they have collected for such purposes. Merilly, my retiring wound nurse, also hooked me up with a lot of colostomy supplies which I hope to leave for them in Soddo. Most importantly, I'm finding some compact obstetric and orthopedic atlases/ manuals as this trip promises to put the word "General" back in General Surgery.
I went to Wal-Mart yesterday with my brother in law Brandon who is here from California. We had fun perusing the travel section to make sure I have all the necessary items. Do you know how hard it is to find Sunblock in Northern Wisconsin in January? It's not exactly on prominent display, but I did manage to find a bottle of SPF 70 (I feel whiter already). I also got some very necessary chocolate for the plane trip.
This morning was a neat time at church. We've only been attending for 6 months (I'm not even a member yet since an emergency operation caused me to miss the congregational meeting), yet they had me come up front to pray for me and send me off. Moreover, many men in the church have offered to assist Wendy in the near-daily ritual of snow removal - We've already had record snowfall this winter. The local Orthopods and Gynecologists have also offered their electronic assistance if I run into stuff I don't recognize (as certain as death and taxes).
Well, I'm off to measure my suitcases to make sure they don't exceed the maximum volume criteria for Lufthansa. Keep me and the girls (Wendy, Emma, and Tess) in your prayers. I'll try to keep this blog updated throughout the trip as much as possible, but I've been warned not to expect too much down-time.

-Matt