After a late night last night working past midnight, we're back up and at it for morning huddle with Amy who's standing in for Nathan today, and morning rounds on the ortho patients on the service. The first case on is a cute little tyke who needs a cast change. He's staying over in the "white house," which is a nice little euphemism for a one-room bungalow on the hospital grounds where long-term patients can go and stay if they've come from far away and need frequent trips to the OR or dressing changes that otherwise would have required them to travel a long way multiple times in a short period. I bring him back to the OR (if you want to start early or work late you bring the patients back yourself, which I suppose is only fair). The poor kid's an orphan but he's been staying here at Adventiste for the past few weeks all by himself. Patients like him are cared for by other patients or family members they share a room with. They share food, change bedpans (food and bedpans are family responsibilities here, not the nurses'), and generally keep an eye out for each other.I found this out when I had to run back to his room because I'd forgotten his chart. "Le dossier de l'enfant?" I ask the older gentleman in the bed next to the kid's. All at once everyone chimed in and almost in unison pointed out where they were keeping it for him. (You keep all your paperwork and xrays and carry them around with you, and that's the medical record system.) I also discovered this last night when I checked up on the last patient of the night, the one who got done at midnight. He couldn't have been in his room more than a few minutes, but as he was stable and it was a relatively small surgery, his father was already back to caring for an older gentleman who didn't have a family and was in the bed on the other side of the room. It's really touching to see. It gives you hope that with all the crap these folks have been through that because they stick together like this, this country will see a much brighter day in years to come.
Another highlight for me today was putting in a Kuntscher nail. Never done one before. Gerhard Kuntscher was a German surgeon charged who pioneered the technique of fixing tibia fractures (your lower leg bone) with intramedullary rods back in World War II. He'd get Luftwaffe pilots back up flying in a few weeks may not even have been healed enough to walk, but could push pedals well enough to fly. He performed this for American POW's, which prompted some people to call for trying Dr. Kuntscher on war crimes! Now, it's the standard of care for femur fractures that occur in the shaft (the long tubular part in the middle) and one of the mainstays of treatment for tibia fractures. Funny how times change. Anyway, you never see these things anymore back home in the States, unless it's on the x-ray of an older patient. They still have them here at Adventiste and they are stll commonly used in the developing world. They used them back in Uganda when I volunteered there a few years ago. We used one today to fix a pathologic humerus fracture in a poor lady's arm who's got skeletal metastases all over her body from cancer. Most of the time broken humeri heal pretty well but there are certain instances when you fix them, generally with plates and screws, or rods. I think hers is one of those instances. She's hurting a lot when I see her after surgery but all I can do is order pain medications and promise that things will get better tomorrow. And a little bit better that day after tomorrow.
The last case we were going to do tonight was another lady with a broken hip. Unfortunately there's a lady with a bowel obstruction who needs emergency surgery, and there's only one working anesthesia machine in the hospital right now and it won't get working again until they can fly in a technician from the States. So I go talk to her and let her know that she's waited all day without anything to eat or drink for nothing, with the promise that we will definitely, definitely get to her tomorrow. It's simply one more promise you end up making a lot here. You can only do your best to keep it.
After a late night last night working past midnight, we're back up and at it for morning huddle with Amy who's standing in for Nathan today, and morning rounds on the ortho patients on the service. The first case on is a cute little tyke who needs a cast change. He's staying over in the "white house," which is a nice little euphemism for a one-room bungalow on the hospital grounds where long-term patients can go and stay if they've come from far away and need frequent trips to the OR or dressing changes that otherwise would have required them to travel a long way multiple times in a short period. I bring him back to the OR (if you want to start early or work late you bring the patients back yourself, which I suppose is only fair). The poor kid's an orphan but he's been staying here at Adventiste for the past few weeks all by himself. Patients like him are cared for by other patients or family members they share a room with. They share food, change bedpans (food and bedpans are family responsibilities here, not the nurses'), and generally keep an eye out for each other.I found this out when I had to run back to his room because I'd forgotten his chart. "Le dossier de l'enfant?" I ask the older gentleman in the bed next to the kid's. All at once everyone chimed in and almost in unison pointed out where they were keeping it for him. (You keep all your paperwork and xrays and carry them around with you, and that's the medical record system.) I also discovered this last night when I checked up on the last patient of the night, the one who got done at midnight. He couldn't have been in his room more than a few minutes, but as he was stable and it was a relatively small surgery, his father was already back to caring for an older gentleman who didn't have a family and was in the bed on the other side of the room. It's really touching to see. It gives you hope that with all the crap these folks have been through that because they stick together like this, this country will see a much brighter day in years to come.
Another highlight for me today was putting in a Kuntscher nail. Never done one before. Gerhard Kuntscher was a German surgeon charged who pioneered the technique of fixing tibia fractures (your lower leg bone) with intramedullary rods back in World War II. He'd get Luftwaffe pilots back up flying in a few weeks may not even have been healed enough to walk, but could push pedals well enough to fly. He performed this for American POW's, which prompted some people to call for trying Dr. Kuntscher on war crimes! Now, it's the standard of care for femur fractures that occur in the shaft (the long tubular part in the middle) and one of the mainstays of treatment for tibia fractures. Funny how times change. Anyway, you never see these things anymore back home in the States, unless it's on the x-ray of an older patient. They still have them here at Adventiste and they are stll commonly used in the developing world. They used them back in Uganda when I volunteered there a few years ago. We used one today to fix a pathologic humerus fracture in a poor lady's arm who's got skeletal metastases all over her body from cancer. Most of the time broken humeri heal pretty well but there are certain instances when you fix them, generally with plates and screws, or rods. I think hers is one of those instances. She's hurting a lot when I see her after surgery but all I can do is order pain medications and promise that things will get better tomorrow. And a little bit better that day after tomorrow.
No comments:
Post a Comment