Katie en Laurent bij de Khmer: When you have two...

Under a rosy-fingered sky I went for a jog in the twilight. Since our hotel is on the far northern side of the town, I soon left the busy streets and I was running in the midst of the greenery. On my left the red glow of the setting sun shone through the trees. But soon I had to curb my enthusiasm and slow the pace. Although almost dark, the air was still very humid and it felt like running wearing a wet wetsuit. Nonetheless I was very pleased with the little escapade!

Fridays always start with an extensive ward round. I need about 10 minutes for every patient (in the meantime dr Rada and Cheavuthy manage to do 10 patients). Today was somehow more confronting than before. My first patient was an 18-year old who had been in a road accident. The charts said he was severely comatose, but when I went to see him he opened his eyes, spoke and could move his left arm. But he was still very somnolent. Since he was in such a bad shape neurologically over the past few days, everybody had agreed to wait for the (expensive) investigations like x-rays etc. No point in diagnosing a fracture if he's brain-dead is somewhat the line of thought. So no x-rays to orientate me I soon spotted that this young man, who didn't complain of any pain anywhere, could not move his arm. Under a single "sterile" cotton swab a bulging muscle mass was visible. I took hold of his arm and immediately felt the crepitations of the broken bone fragments inside: open fracture of the humerus. Closer inspection of the legs revealed that his right thighbone was in an odd unnatural angle and when I exorotated his left leg the movement somehow didn't make it all the way to the hip. So fractures of both femurs. No feeling in the toes: peripheral or central neurological fall out. Without MRI it's mostly guessing ( and waiting ).
The second patient had lost all four fingers in a machete "accident". Two of them had been reimplanted but he screamed when the bandages were taken off. It looked extremely painful.
A few patients further down the track I saw the young girl who had lost her scalp. She was already feeling better, no fever; so everything looking good for the skingrafts! But the nurse asked me if she could change the dressings on her legs ( where the grafts were taken ). I agreed that it was time, but soon this 16 year old girl was howling with pain. I myself had put the fatty bandages (that are supposed to be non-stick). It was horrible to have to stand there and watch it. After that I went to see a patient whose file only said "accident de travail". The back of his foot was one big pus-filled hole with only one tendon remaining crossing the gap like a bridge. The violent smelled nearly flattened me. Infected wound: antibiotics and debridement.
The last patient was a young man who had a severe trauma to his right arm a week ago, and due to massive swelling of the muscles he developed a compartment syndrome (that's when the nerves and vessels get crushed because of the pressure of the swelling). So the doctors performs a fasciotomy (to give the muscle room to expand). But since then he had not recovered neurologically. Nonetheless he is always in high spirits, always smiling, always with his girlfriend by his side. Today he asked about the recovery of motor skills in his arm. I admitted that it wasn't looking very good, but that nerves grow very slowly and it might still improve over the months. I asked about his job and he said he was a truckdriver. I said in the future his girlfriend might have to shift the gears for him. They both laughed very hard. Mentally they are for sure unbeatable. What a tough people.

Dr Lemsokong took Katie and the (new) New Zealand student (Angela) on a little trip since they had no OR today. They bought 'kuy', a very special kind of fruit, only to be found in cambodia. This resulted in us being pointed at and amazed cambodians whispering "kuy" anywhere we went with it. Dr lemsokong has overloaded us with his aphorisms over the last week. One that will certainly stick in our memory is:
"In cambodia we have a saying; you can only have one wife! If you have two: hide one! If you have three: hide two!". He's alot of fun to be around!
Rie, a OR nurse, saw us with the Kuy and promptly gave us a bag of fresh sweet mango's to compensate for the sour Kuy. She was also convinced that if there wasn't anybody scheduled for operation in the afternoon this must mean that everybody in Siem Reab was healthy!
Dr Rithy invited us to the cambodian new year party at the hospital on april 11th. By that time we should accually be back in Phnom Penh, but maybe we can just linger here for a few days longer....

Some pictures below (watch out; some medical ones might be shocking!)