Day 5: Osteotomy, Release/Repair, and Bar/Club

I started my day with a 30 minute run to the beach and back with Sunny and Joe. After we got back at around 7:30am, I showered and got ready for the hospital. We left at the usual 8:30am. My group - consisting of Courtney, Joe, and myself - headed up to the Major Theater again. And finally I remembered my camera!

Coast Provincial General Hospital

Part of the hospital from the Major Theater doctors' lounge.

It took a while to find face masks. While searching the theaters for them, a doctor explained that each of the four theaters has its own type of surgery that takes place. I didn't understand what he said Theater 1 is for, but Theater 2 is for gynecological surgery, Theater 3 is for orthopedic surgery, and Theater 4 is for neural surgery and more intensive surgeries (it has the most sophisticated equipment). Eventually someone brought a box to Theater 3, where we decided to stay and watch a humeral osteotomy.

Surgery #1

DX: Fractured left humerus

Operation: Proximal humeral osteotomy

A stray bullet had entered the patient's upper arm anteriorly (from the front) and exited posteriorly (from the back), causing his proximal humerus (near the shoulder) to shatter. His arm was very flimsy, almost noodle-like, because of the injury. Unlike yesterday's osteotomy, where I mostly stayed by the surgeon to watch how he went about repairing the mal-unioned femur, this time I mostly stayed by the anesthesiologist, who explained some of their techniques for monitoring the patient's condition during surgery (the monitor they use for watching heart rate, oxygen content, etc. was very similar to ours), and allowed us to see the patient's vocal cords before he inserted the breathing tubes.

The operating room in Theater 3.

The anesthesiologist's equipment in Theater 3.

The surgeon repaired the fracture by cutting the shattered humerus ends so that they were more evenly cut, drilling a scaffold through the bone to hold the top and bottom pieces together, then drilling screws laterally through the bottom piece and top piece to hold the scaffold in place. The interventional radiologists helped him place the scaffold and screws in the proper locations. Once the surgeon started putting in stitches, we left Theater 3 and went to Theater 4 to see what was happening there.

Between the surgeries we ran into some other students from our program, who filled us in on some interesting news. One of the patients from my first full day at the hospital, the one who had jumped off a bridge onto the road below (in an attempt at suicide), completely fractured his tibia, and whose leg I had held in Casualties as nurses put his leg on a stent, had woken up after his surgery in a psychotic state. He broke the window behind him, grabbed a shard of the glass, and started running down the hall with it. Security guards caught up to him and beat him with their batons. We're not sure what happened to him after that.

Surgery #2

DX: Contracture of the right middle finger

Operation: "Release/repair"

When the patient was 1 year old, a fire had burned his right hand so that his fingers were stuck to his palm. I'm not sure if they couldn't do the surgery until he was older, or if his parents just waited a long time to get the surgery done, but he is now five and a half years old. When my group entered the room, they were already making incisions in his wrist and moving skin from his forearm to his palm. His fingers, which had metal poles sticking out of them (I guess to help stabilize the fingers while separating them from the palm), were already separated from his palm.

There is only one anesthesiologist and one anesthesiologist assistant for all four theaters, and they are frequently running back and forth between cases. The anesthesiologist was not in the room, but Mwachoki, the assistant, appeared to not be busy, so I talked to him. I had noticed when I entered the room at the ventilator was off, and that the patient appeared to be taking his own quick, shallow breaths. I asked Mwachoki why the patient didn't need muscle relaxants (which was evident since his diaphragm was still breathing for him). He told me it's because he is a child, and went on to explain how they put children versus adults to sleep.

All patients receive oxygen, nitrous oxide, and halothane (an anesthetic - puts the patient to sleep). Thiopental or "sip." (not sure what it stands for) are then administered as short or long term anesthetics, respectively. In children, this is all they receive; in adults, they also receive Scoline (short-term muscle relaxant) followed by either Atracurium (intermediate-term muscle relaxant) or Pavulon (long-term muscle relaxant). To reverse the anesthetics and muscle relaxants, atropine and neostigmine are mixed in a syringe and injected through the cannula.

We left a little early to meet with the rest of our group in the Minor Theater. The patient there had been the driver of a hit-and-run, and people had caught up to him and beaten him over the head. He was, for the most part at least, unconscious as the UK medical students from my group and some Danish medical students were cleaning his head gashes and injecting local anesthetic. They taught me the basic technique of applying sutures, and I stitched two myself. The hardest part was using the tools, but I got more used to it the more I used them. Finally we finished at the hospital and headed back to the housing complex.

We ate lunch and relaxed, playing card games or talking, until dinner. Joe chased a chicken into the main house and we cornered it in one of the bathrooms. A few people went to the market, but I didn't need anything this time. After dinner, we had planned to go downtown to one of the local bars/clubs, so we played some games for a while and then headed out.

Caught the little chicken!

The place we went to used a metal detector to search for weapons, and then admitted us without checking IDs or charging cover. Otherwise it was like just about any other bar/club in the US. There was a bar, multiple tvs, tables/chairs, a dance area, and music. It turned out to be a fun place, even though the 13 or 14 of us who went were the only foreigners there.

At the bar/club!

After we got back, we went for a quick swim and went to bed.