June 27, 2008

Today was pretty good (I say that alot huh, lol). We rounded on the OB ward first, seeing all the patients who had a C-section done. The lady who I did the sub-cutaneous suture on is in pain from the surgery but she is doing fine. Her would looked beautiful if I should say so myself :). Another patient (an extremely young mother) had been in the ward for 9 days but we couldn’t send her home because the bottom of her C-section would wouldn’t close. The doctor asked me to suture it closed so I did it. Saying that the young mother was difficult would have been an understatement. She cried and squirmed from the time that she got on the table to the time that I finished. The clinical officer walked me through the procedure and then left. So I began anesthetizing her would by inserting a needle filled with lidocaine in the skin around it. Somehow I ended up spraying the lidocaine all on my face but eventually she couldn’t feel anything (although she still continued to cry). Then I had to take a scalpel and cut the margins of her wound so that it would be symmetrical. After that I started to put the sutures in (Silk 2-0). No matter how many times I locked the knot it wouldn’t hold as tight as I wanted. One of the scrub techs who works in the OR was walking by and told me that I was biting too deeply when I was going through the skin. I started to pass the needle right under the skin and the knots held perfectly. I think it is important to be open to all counsel as a physician in training. The more you listen, the more you learn, the better doctor you will become. Ego and pride can hurt you and the patient.

Being out here is really great. You can just aobut do anything after they show you how. On my list of to dos is:

  • lumbar puncture/spinal anesthetic
  • periocentesis
  • start an IV
  • more suturing
  • more vaginal exams
  • more baby deliveries

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I fit in a nice hot shower around 16:00 hours because we hadn’t had a power interruption in awhile, meaning that it was going to happen soon. We went down to the hospital to see what was going on. A mother had just come into the OB war and was experiencing contractions. This patient was odd; she didn’t know how many months pregnant she was, she didn’t know how old she was, and she didn’t even remember how many children she had. From looking at her abdomen she had obviously had a previous C-section so as the contractions grew worse we took her to the OR. My wife assisted the surgery and I assisted the nurse anesthetist. I inserted the spinal anesthetic needle but I didn’t feel the pop that I expected I would (signalling that I was in the sub-arachnoid space where the CSF lies). The nurse anesthetist took over and it took him some time to get it too (so I didn’t feel as bad, lol). I’m going to try until I really get it.

So yeah, they cut the baby out of the uterus and pulled out a silent premature babe. We had no idea the baby was premature because we had no idea how many weeks pregnant the mom was. I worked with the nurse anesthetist to revive the little baby boy. At certain points her O2 saturation was around 4%. After 10 minutes of her O2 sats were in the 80s and I felt like God was answering my prayers. I truly did not want to go to sleep after having a baby die in my hands. I stuck the section deep down into the baby’s throat and finally he eeked out a small cry/wimper. We took him to their “nursery room” which really showed the problem many mission hospitals have. As you can see in the picture:

the nursery has two incubators, but they are both broken. So the baby instead had to be wrapped in like 5 blankets, and then they put on a floor heater in the room. Like I said before, there is room for many medical professions on the mission field. Someone who has been trained in maintenance and repair of medical instruments and machines would be just as vital to the hospital as the doctor. If the Lord is calling you, don’t resist. You can touch so many lives when you are working in His will.

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