Days 16 and 17: Crazy Night, Morning, and Afternoon Shifts

Since yesterday and today melded together, separated by no more than 4 hours of sleep, I will write about them as a single post. Yesterday morning I slept in until about 8pm. Not much happened before my shift started; I mostly just ate, went swimming, and hung out until it was time to head out. At 8pm, we took the tuktuk to the hospital.

Dinner was spaghetti with beef sauce.

When we arrived, the hospital was the most empty I've ever seen it. Many of the areas, such as the radiology rooms and Minor Theater, were closed and locked. We headed to Casualty, which wasn't nearly as active as I was anticipating. We helped save a woman suffering from an asthma attack (apparently the nurses in Casualty just ignore asthma attacks, because they didn't do anything), and I watched one of the doctors put in cannulas. I was going to get a chance to try putting in a cannula (which was very exciting... I consider the successful insertion of a cannula as my ultimate test for this trip), but we found that the patient already had a cannula on the other side of his elbow, so there was no need for me to put one in his hand. Hopefully I'll get more chances to put a cannula in before I leave.

We also headed up to a general ward to see if anything was happening. We found a baby with cephalohematoma (collection of blood between the skull and the scalp, causing a bulge on the head). Since there wasn't anything we could do in the general ward, we went back to Casualty and followed doctors around for a while. We heard that there was a spina bifida surgery (an intense neural surgery) in the morning at 8:30am, so we decided to plan on watching it.

By 2:30am, we were tired, and there weren't any new interesting cases for us to examine, so we went for a walk around the hospital. We happened to find our van that drives us around and the driver asleep in it. There was also a really cool praying mantis on the van that we stared at for about 5 minutes and poked with a stick. Finally, we headed back to the housing complex. I went to bed at 3am, ready to get up early for the surgery we agreed to see.

Praying mantis on the van! It flew away after a few minutes.

I woke up at 7am, ate breakfast, and got ready to return to the hospital. We left in a tuktuk at 8:30am and arrived at around 9am. As expected the surgeries were running late, mostly due to equipment failures (they couldn't get the Bovie and bipolar coagulation forceps working for a long time). They also changed the schedule, so that the spina bifida surgery came third in line. We decided to stay to watch the first one, then get lunch during the second, and come back for the last. We scrubbed into Major Theater and headed to the fourth theater room.

Surgery #1

DX: Cephalohematoma

Operation: Excision

The neural surgeries we were about to see weren't simple ones. When we walked into Theater 4, we were greeted by a neural surgeon from Spain, and neural surgery resident from Italy (doing his residency in the Czech Republic), and the resident's nurse from the Czech Republic. The team met up in Mombasa a few days ago and are here until Wednesday. It was interesting to learn that neural surgery residency takes 7 years, and the resident in this group was in his 4th year.

They arranged the three surgeries in order from simplest to most complex, with spina bifida being an obvious last. It turned out that the first surgery was the excision of the cephalohematoma of the baby we saw in the general ward last night. Apparently trauma from the birth caused a fracture in the baby's skull. The fracture healed by itself, but the bleeding caused a collection of blood to build up between the periosteum and connective tissue layers. The surgery was somewhat quick (went from 10:30am to 12:30pm) and involved cutting through the connective tissue and draining the blood.

After the first surgery, we left for lunch (at 1pm). We took a tuktuk to a restaurant called Caribou, which is near our housing complex. I got coconut-seasoned fish and a Toblerone milkshake (a great mix of much-needed calcium and more-needed ice cream). We stopped by the housing complex before heading back to the hospital at 2:30pm.

Coconut fish and Toblerone milkshake for lunch.

Surgery #2

DX: Spina Bifida

Operation: Closure

Spina bifida, Latin for "split spine," is a birth defect in which the neural tube does not close properly (instead of forming a closed tube, it is open and allows cerebrospinal fluid to leak out and form a bubble outside the spine). The condition often results in partial paralysis (especially paralysis of the legs), and while surgery does not cure the paralysis, it does close the neural tube and prevent infections that could cause more nerve damage. Spina bifida is very rare in developed countries (it is preventable by consuming adequate folic acid prior to conception), so getting to see this surgery up close is a big deal for us.

The Italian neurosurgery resident (left) and Spanish neurosurgeon (right) closing the spina bifida.

We arrived in Theater 4 just in time for the surgery we had been waiting to see. They had already finished the meningocele excision, had put this new patient (3 year old) to sleep, and were cleaning the area of operation with iodine. They cut the bubble of cerebrospinal fluid protruding from the patient's back and drained out the large amount of fluid that had accumulated. The Spanish surgeon and Italian resident worked together to suture the spinal components closed and clean up any infected tissues. They were almost done by the time we decided we should probably head back and eat dinner. We left the hospital at about 6:15pm.

By the time we got back, I was exhausted. I ate the dinner Dollas had made, which (for the first time) was fish and was arguably the best meal so far (even after having fish for lunch too). It was a long two days, filled with much hospital time and little sleep, so three of the four of us decided to take tomorrow off. We went to bed early, eager to catch up on lost sleep.

Dinner was fish, rice, and spinach.