Finally, I don't feel like I'm lying in my blog header anymore! Today I spent my first day in the hospital, and I now really am a General Surgeon serving in Nepal. Although this first week or so I'm mostly just hanging out with one of the other surgeons working here...they kindly haven't put me on my own QUITE yet.
I apologize in advance if this post is too "medical" for some of you. They won't all be like this!
It was a pretty straight-forward day. Started with team handover and morning report, which happens every morning at 7:45. The interns and residents give a summary of what's happened in the hospital over the last 24 hours, so that we all have an idea of what's going on. Then we made ward rounds. I'm not sure how many patients we saw, but there was certainly a range of problems. There was a baby with burns on the leg but who can't get a skin graft until her diarrhea settles down (risk of infecting the graft). There is a woman with a badly burned right side whose skin graft isn't taking very well. They are the only 2 burn patients in the hospital right now. Apparently there were several more last week, but all the others were getting so sick that their families just took them home to die. Such is life in Nepal.
There was someone recovering from surgery for an upper GI bleed, a man with a chest tube in each side for bilateral pneumothoraces (collapsed lungs) after a fall, another man in a halo because of a C-spine injury (who is actually recovering some of his extremity movement, and has been here for 4 weeks already and hasn't developed a bedsore, thanks to good nursing care and a fancy mattress with air pockets that inflate and deflate at different times to constantly redistribute his weight), a young boy recovering from surgery for a ruptured bladder and urethra after a fall, someone else with a hip fracture in traction, a man with some kind of immunodeficiency with multiple chest wall and back abscesses, a pancreatitis, someone else being monitored for a head injury after a fall, a couple postop patients who had ureteral stones (in the tube connecting the kidney and the bladder) removed, a kid with Henoch-Schonlein Purpura with a possible hydrocele, and a bunch of other things that I can't think of right now
Oh, and there was one post-op appendectomy patient. Fairly routine for a general surgeon, but the sweet part of this story is that the 2nd-year family practice house officer (kind of like a resident) who is hoping to get into a surgical residency, was telling us the story, and beaming from ear to ear because he had done the appendectomy skin-to-skin himself (with the staff orthopedic surgeon, who was the one on call that night, just standing closeby). He had done a great job, and he was thrilled. It was neat to see how visibly excited he was. Makes me excited about the teaching component of my job here.
Before the OR starts, we have our all-important chiya (tea) break in the hospital canteen. Today I had chiya and samosas. The OR started around 10:00 or so. I basically joined another surgeon for his OR day, but we split the cases. For my first day I got a couple of easy things...removing a small mass (looks benign) off the shoulder of a 9-year-old girl, and a straightforward inguinal (groin) hernia repair. For you surgically minded out there, yes, we have prolene mesh here, and I used it and did essentially a lichtenstein repair under spinal anesthesia. For the rest of you, you don't care...sorry! Prolene mesh is pretty cheap (less than $10 for a large piece...you cut a piece out of it to get the size you want, and then the rest gets resterilized and used on the next several patients, too). We also have a good variety of suture materials...all the ones I'm used to working with at home, so that's great. Gloves without holes in them get removed, sterilized, and reused. And, of course, we have cloth drapes. There is one doctor (Nepali) who has some anaesthesia training, and another one in training at the moment, and there are nurse anaesthetic technicians. We can do both general and local/regional anaesthesia here.
The last case of the day I did together with the other surgeon. It was a bit complicated. Looked like some kind of abscess (pocket of infection) inside the abdomen, but we couldn't tell from the ultrasound what it was or where it was coming from (Yes, we have ultrasound here. No CT, of course). Turns out, in the end, we're pretty sure it was his gallbladder. It was HUGE, and full of stones and really (sorry) foul-smelling pus. And it was stuck to everything...the colon, the duodenum, the liver, etc. We worked in there for quite awhile, and eventually opted to just remove a portion of the gallbladder (the part we'd managed to free from everything else), and then stick a few drains in and quit before we did something really bad (like perforate his duodenum) while trying to do something good (like take out his gallbladder). So that one was a bit of a challenge, but at least it was very much within the realm of what I'm used to...i.e. operating inside the abdomen!
I had an intern with me, and she assisted and closed the skin at the end and did a great job. As I mentioned, I am excited about teaching here, though I will still be learning a lot at the same time. I do believe that's what I've been brought up to believe a doctor should be...both a student and a teacher at the same time. So I guess that's okay.
I was happy to discover that I have not forgotten how to operate...nor have I lost my love of surgery and medicine. I had been starting to wonder after almost 6 months of not being in the hospital how I'd feel being back, but I feel very much at home...at the same time as this is all very new and will be for quite some time.
I apologize in advance if this post is too "medical" for some of you. They won't all be like this!
It was a pretty straight-forward day. Started with team handover and morning report, which happens every morning at 7:45. The interns and residents give a summary of what's happened in the hospital over the last 24 hours, so that we all have an idea of what's going on. Then we made ward rounds. I'm not sure how many patients we saw, but there was certainly a range of problems. There was a baby with burns on the leg but who can't get a skin graft until her diarrhea settles down (risk of infecting the graft). There is a woman with a badly burned right side whose skin graft isn't taking very well. They are the only 2 burn patients in the hospital right now. Apparently there were several more last week, but all the others were getting so sick that their families just took them home to die. Such is life in Nepal.
There was someone recovering from surgery for an upper GI bleed, a man with a chest tube in each side for bilateral pneumothoraces (collapsed lungs) after a fall, another man in a halo because of a C-spine injury (who is actually recovering some of his extremity movement, and has been here for 4 weeks already and hasn't developed a bedsore, thanks to good nursing care and a fancy mattress with air pockets that inflate and deflate at different times to constantly redistribute his weight), a young boy recovering from surgery for a ruptured bladder and urethra after a fall, someone else with a hip fracture in traction, a man with some kind of immunodeficiency with multiple chest wall and back abscesses, a pancreatitis, someone else being monitored for a head injury after a fall, a couple postop patients who had ureteral stones (in the tube connecting the kidney and the bladder) removed, a kid with Henoch-Schonlein Purpura with a possible hydrocele, and a bunch of other things that I can't think of right now
Oh, and there was one post-op appendectomy patient. Fairly routine for a general surgeon, but the sweet part of this story is that the 2nd-year family practice house officer (kind of like a resident) who is hoping to get into a surgical residency, was telling us the story, and beaming from ear to ear because he had done the appendectomy skin-to-skin himself (with the staff orthopedic surgeon, who was the one on call that night, just standing closeby). He had done a great job, and he was thrilled. It was neat to see how visibly excited he was. Makes me excited about the teaching component of my job here.
Before the OR starts, we have our all-important chiya (tea) break in the hospital canteen. Today I had chiya and samosas. The OR started around 10:00 or so. I basically joined another surgeon for his OR day, but we split the cases. For my first day I got a couple of easy things...removing a small mass (looks benign) off the shoulder of a 9-year-old girl, and a straightforward inguinal (groin) hernia repair. For you surgically minded out there, yes, we have prolene mesh here, and I used it and did essentially a lichtenstein repair under spinal anesthesia. For the rest of you, you don't care...sorry! Prolene mesh is pretty cheap (less than $10 for a large piece...you cut a piece out of it to get the size you want, and then the rest gets resterilized and used on the next several patients, too). We also have a good variety of suture materials...all the ones I'm used to working with at home, so that's great. Gloves without holes in them get removed, sterilized, and reused. And, of course, we have cloth drapes. There is one doctor (Nepali) who has some anaesthesia training, and another one in training at the moment, and there are nurse anaesthetic technicians. We can do both general and local/regional anaesthesia here.
The last case of the day I did together with the other surgeon. It was a bit complicated. Looked like some kind of abscess (pocket of infection) inside the abdomen, but we couldn't tell from the ultrasound what it was or where it was coming from (Yes, we have ultrasound here. No CT, of course). Turns out, in the end, we're pretty sure it was his gallbladder. It was HUGE, and full of stones and really (sorry) foul-smelling pus. And it was stuck to everything...the colon, the duodenum, the liver, etc. We worked in there for quite awhile, and eventually opted to just remove a portion of the gallbladder (the part we'd managed to free from everything else), and then stick a few drains in and quit before we did something really bad (like perforate his duodenum) while trying to do something good (like take out his gallbladder). So that one was a bit of a challenge, but at least it was very much within the realm of what I'm used to...i.e. operating inside the abdomen!
I had an intern with me, and she assisted and closed the skin at the end and did a great job. As I mentioned, I am excited about teaching here, though I will still be learning a lot at the same time. I do believe that's what I've been brought up to believe a doctor should be...both a student and a teacher at the same time. So I guess that's okay.
I was happy to discover that I have not forgotten how to operate...nor have I lost my love of surgery and medicine. I had been starting to wonder after almost 6 months of not being in the hospital how I'd feel being back, but I feel very much at home...at the same time as this is all very new and will be for quite some time.
