Katie en Laurent bij de Khmer: Le Moustique est sterile...

Monday 7th; after ward rounds on monday morning I headed to the OR for the day's surgery but there wasn't an anesthesist in sight. Dr Rada explained that the hospital director had announced that all salaries would be paid in full at 9.00 AM. Since by now it was already 10.00AM there was clearly a delay in payment. Dr Dara also told us that a waiting period of 2-3 months for the monthly salary was standard... he's a very patient man. At 11.00 AM we decided to postpone the operation until the afternoon; so we wheeled the patient back whence he came and retreated to have an early lunch. On the way we crossed an indoor market aerea and I decided to ask once more for a Hammock (all cambodians own one and sleep in it at least 3-4h during the day!). But I could only find cheap tourist stuff and had refrained from buying anything until today. The shopkeeper told me to wait and after a while jumped from behind the corner with a magnificent army style hammock complete with mosquito net. Nice but maybe a little extravagant for my noon nap. She also showed me some simple but sturdy nyloncanvas hammocks which were very much to my liking. After some harsh bargaining we walked away with it for 7$ when she wanted 12$... so reasonably happy about it (while she obviously wasn't!). I'll soon posted some action pictures of me and my hammock...
The afternoon kicked off with an acute appendicitis and the femur and tibial fracture afterwards. Katie was assisting dr Vuthy on the appendix (and I was watching, waiting for the traumasurgery to start), when suddenly a mosquito landed in the middle of the operating field. Quickly chased away by dr Vuthy he added "c'est pas grave, le moustique est stérile!" and smiled. We all laughed very hard!

Tuesday 8th; international womens day! Celebrated as a national holiday in Cambodia we were only due in the OR at 09.00AM. It is a remarkable fresh day (about 20°C) covered with clouds as wait in front of the surgery doors until suddenly; out comes dr Rithy to tell us that there is an abdominal abces waiting to be drained but no staff to be found (because of the holiday). The session is recessed until the afternoon. Back in the OR the drainage is nearly at an end but my supervisor dr Rada is happy to have an assistant for the EUG he's about to start. An EUG is a pregnancy which isn't located in the uterine cavity and can cause serious problems (like bleeding). Strangely enough the patient seems quite fine. Most of them do as a matter of fact. She complains about pain but shows no sign of discomfort. I was already convinced that this was bad diagnostics and a terrible candidate for surgery... but as soon as we open the abdominal wall a gush of old blood comes to the surface. Katie stands in as instrumenting nurse for the occasion and off we go emptying the belly. Big chunks of coagulated blood are dug out manually and the suction device is working full time. The source of the problem is located and dr Rada performs a salphingectomy. Then we continue cleaning the bowels of the bloody mess. Dr Rada and I do one side each and he urges me to put my hand inside the abdomen until I can put my fingers between the liver and the diaphragm (to avoid quantities of blood remaining there when the patient is in a supine position). As I see my hand disappearing inside I have the feeling that my whole arm is inside the patient (luckily for her it wasn't). But an interesting exercise one the less! We pour large quantities of saline solution in the belly to wash and once we aspirated it again, we can start closing. Dr Rada does the fascia and the muscle wall. I finish the subcutaneous fat and the skin with very delicate (and time-consuming) stitches. Katie approves of the work!