TGIF

Images from top down - the church, houses occupied by doctors/hospital staff, a typical mango tree. More houses.

Warning - this blog has a lot of medical jargon - sorry in advance to non-medical people, just came off of a long call night and work day today!

Hope you had a good week back home. I am definitely glad its Friday! The past 24 hours have been a blur because of a very busy call night last night, and work day today! And to top it off, my work day ended arguing over a chicken..... I admitted two patients last night s/p trauma. Having to rely on my med school trauma and ortho experiences is difficult and to make it more interesting I usually understand about every third word when I take a history in Kiswahili!

The first trauma case was s/p MVA came with a compound fracture of the humurus and femur. He was transferred from a nearby hospital......Later in the evening a 5 day old girl came with abdominal distention, constipation and nausea/vomiting, most likely an obstruction. An NGT put out 150 cc of fecal material; she received an enema this morning. The highlight of my call came around 4:15 this morning. Our teenager who induced an abortion with local herbs, and then had a D&C had been spiking fevers, without responding to antibiotics. She developed an acute abdomen and we took her to the OR at around 5 for laparotomy/lavage for peritonitis and she had a ruptured abscess with purulent fluid filling her abdomen.

There were no gyn cases on the schedule today, so I assisted on a laparotomy for a enterocutaneous-fistula repair that developed after a hysterectomy. Interesting case!

The work day was almost over until I glanced at the last patients chart. She was lying on a stretcher outside the theatre. The history said abdominal pain, and vomiting. There were no vital signs, and a one line exam, then impression - ectopic pregnancy. We took the patient for an urgent ultrasound that showed free fluid and an adnexal mass, consistent with ectopic. She was pale and tachycardic so we called for emergency laparotomy. Emergency ended up taking about one hour because soon after diagnosis, we had a downpour of rain. The nursing staff and anesthestists must have taken that as a sign for a break and did not transport the patient back from the ward. Nevertheless, about an hour later, we suctioned out about a liter of blood from her abdomen and removed the left tube and ectopic pregnancy.

Regarding the chicken - Yesterday I was walking down the street to the post office with one of the local boys who works in the kitchen and has the one and only key to the post office. Making small talk, I asked him if he knew where I could buy some chicken. He said he has some and told me to stop by the store tomorrow (today). Just before going back to the OR with the ectopic one of the nurses stopped me and told me a man was waiting to sell me his chicken. I was in the midst of trying to get the patient back to the OR and mistakenly told him to wait until after the operation. I walked out of the OR heading home when I saw the boy and an older man with a live chicken. He stopped me and insisted that I buy his chicken. I tried to explain, I did not want to buy a live chicken because I don't want to kill it, and more importantly have a live chicken running around in the house! He was very dissapointed, but I think I learned my lesson - careful what you wish for in Kiswahili. I walked back home with the tune of Curb your Enthusiasm ringing in my head.