Up at 6.30 I was packing in my bacon and eggs in a matter of seconds. Ready for rounds! Dr Rada and Vuthy were giving the president and founder of the "sign nail" orthopedic-stuff company a grand tour of the department so that left 50 beds to visit for dr Chea and me. One of the first patients was a young woman who had suffered an injury to the pelvic ring. So I ask to see the radiographs and unmistakenly both pubic rami were broken on the right. I rejoice because only yesterday I had been reading all about these kinds of fractures in my german orthopaedics book (gift from Dr Gotterbarm from Schlierbachen). I check the color of the urine to discover that is it clearly red. I holler to get dr Chea and ask him about organizing an external fixator for the pelvis but he responds that they don't have the right material. Than I ask if it is possible to perform a retrograde urethrography to discover any ruptures but again : no apparatus. Slightly downed by this I decide we'll just have to wait and see...
During the rounds I notice that my shirt is glued to my chest ... it was not particularly hot but extremely humid. At 11h I was happy to leave the department but there were two more tasks for me. First I had intruded upon dr Chea while he was inspecting a big mass on a patients forearm and I'd asked if he planned to remove it in the department or in the OR. "In here of course", and he added "do you want to do it?". I accepted, in the vain hope that he would assist me and check that I wasn't doing anything stupid. But I pull on my gloves and I see him through the first floor window walking towards the OR ... I was by myself. Luckily I had Sokchea, a fluent english speaker/physiotherapist/nurse to assist me. The patient in question was lying in the corridor on a straw mat. So it was going to be a kneeling affair. We pretend to create a sterile environment, I inject the skin with local anestheticum and I make the incision. I look around to see that a crowd has gathered to watch the spectacle and to encourage me on the way! It's harder than I think and with just the scalpel, a clamp and tweezers it's tricky. "Just don't cut anything you're not supposed to", I keep repeating to myself. The lump is about 8cm by 4 and very mobile. But as I am careful to remove it entirely, I am making things hard for myself. The patient starts complaining of pain when I attack what I believe is the vascular pedicle. This means that it isn't... So it must be a tendon or a nerve (let it not be a nerve I mutter under my breath). I peel off another layer to reveal the actual mass itself; smooth and round I dissect it out with my finger and after washing it all with some isobetadine I close the skin (with alot of difficulty: round needles don't cut and with no needle holder but just a clamp it's damn tricky). I extensively test the patients motor and sensitiveness but there seems to be no problem.. just a tendon then... phwew. A little girl who was watching the whole show from nearby remarks that the mass looks very much like "a pig's testicle". I'm sure she's right.
After that I'm rushed to a man with a warm, hard, painful swelling under his right shoulderblade. Probably an abces so I jab a needle in and... bull's eye; bright green pus in the syringe; scheduled for OR asap for extensive drainage.
Mango juice and fried noodles for lunch. Then I hang my hammock at the OR gates and I listen to some music. But before I know it it's quarter to three and I'd slept for an hour. Dr Rada sees me waking up and gives me a sharp laugh... it must of looked pretty funny seeing me climbing out of there still half asleep.
Katie assists on a caesarian and just when I've started changing my scrubs for civilian clothes, i hear "mooy deetut!" One more! An amputation; grangreen of the foot. And sure enough as I walk in ; the nasty (blue)cheesy odour hits me in the face. Dr lemsokong jokes that after amputating it they will carry the leg to the nearby soup restaurant called "Soup Dragon"..." and then I'll invite you!" I know it's very misplaced but since the patient can't understand it I don't refrain from laughing; in a morbid way it's a very funny joke!
After manually sawing the femur (just like in the movies about 16th century naval battles) I drop the leg in a bucket, we close the muscle around the bone, close the skin and it's time to go home. Immediately I notice that it's much cooler; but then thunder strikes and I am rained wet to my underwear when I get to the hotel. Once inside I watch the thunderstorm pick up pace and buckets come pouring out of the sky. Even as I am writing, 1 hour later, the lightning is still illuminating the roofs...
And now... I am hungry again,
L.
No comments:
Post a Comment