Monday, April 16, 2018

ICU rounds with Warren

So, who wants to go on rounds with me?  Don’t worry, we won’t see all the patients, just some of the ones in the ICU. This will give you a little taste of the challenges we face here.

Bed 1 was a disaster. She was a 22 year old girl who came to us after having been operated three times.  It was not clear what they did, but she had stool pouring out of her abdominal incision. I’ve operated on her twice. She had a hole in the duodenum, the jejunum and the cecum. Despite having close the holes, she continued to leak. At a certain point of malnutrition, the body simply do not have the ability to heal.  We explained the situation to her mother, who was hoping for a miracle. There seems to be no other family around and I wondered how the mother would manage when she died. It takes some time to starve to death. One morning I came and found her bed empty. I didn’t need to ask what happened. 

Bed 2 is a man who is paralyzed. I can’t remember if it was a fall or a mine cave-in. He has no feeling or movement below the rib cage. We try to turn him from side to side, but he is already getting bedsores. 

Bed 3 is a motorcycle taxi man who encountered armed assailants.  He said that they emptied a whole clip at him, but managed to only hit his shirt. He then scuffled with one man trying to grab the weapon, but he managed to get shot at point blank range in the thigh.  The bullet shattered his proximal femur but spared the major blood vessels and nerves. We had just enough bone left to put an external fixator on him.  I think it will eventually heal, but it will be a long time. These armed attacks are getting more frequent and alarming. It was a pretty riveting story and he had us entranced. Better than a movie, we all agreed. 

Bed 4 is a young girl who was a motorcycle passenger. It sound like they got clipped by truck. The driver was ok, but she has an open fracture of the tibia/fibula, a complex fracture of the femur and a gaping open wound which goes into the knee. She also happens to be pregnant. So far the fetus seems to be doing ok. 

Bed 6 is an old man who was hit by a motorcycle. He has a open fracture of the tibia and a smashed jaw. He has been confused since the accident. We don’t know if it’s from a head injury or (more likely) from alcohol withdrawal. 

Bed 7 was a moto vs. moto.  He managed to smash in his face. I did my best to elevate the bridge of the nose. This was a disturbing procedure. I pulled his nose out, far enough to make him Congolese, but stopped before if gave him a European nose. I’m not sure what to do about the potato chip fragments of his forehead and frontal sinus. It’s fortunate he did not give himself a frontal lobotomy. 

Bed 8 is another disaster. She was operated on at another facility, where they managed to cut both her ureters.  She came here after two weeks on not passing urine. Her abdomen was full of urine. I operated today and all I could manage to do was to put tubes in he ureters. If she survives I will have to figure out what to do next.  The problem around here seems to be related to too many people doing surgery in poor conditions. This simply should not have happened, and it should have been recognized long before. 

Bed 9 is an army officer who was shot. He came in with a gangrenous foot and there was nothing to do but remove the leg.  He was heading down the road of sepsis, but I think he will make it. 

Bed 10 is an older lady with a thyroid cancer. She had tolerated this slowly growing mass for years before coming in.  It finally reached the point where she couldn’t breath. It was a difficult case and I managed to peel her thyroid gland off of her trachea. It was a palliative operation, at best. If she can breath and eat, I will consider it a success. 

In the hallway is a 15 year old boy who was sucking on the end of a pen.  Somehow he managed to aspirate the little plastic plug of the pen down his trachea. These are really tough cases.  I have a flexible scope that is small enough to get down the trachea. I have a few precious instruments that I can use to snag a foreign body, like throwing a lasso around the neck of a cow.  Manipulating the scope is like trying to control a piece of cooked spaghetti. After a nerve-wracking hour of trying to fish it out, I finally got a snare to slip around it, tightened up and pulled it out.  I am pretty sure that we are the only hospital in eastern Congo that could perform this procedure. The plastic piece was deep in his airway, blocking his right lung. If we hadn’t gotten it out, he probably would have died.  What a stupid think to die from!  Could you ever imagine that sucking on a pen could be lethal?  

I won’t go into more details about the man with the pancreatic pseudocyst, the three old men with prostrate problems, the four paralyzed men, the 5 year old girl with a broken neck or all the other fractures.  

Most of my work is a result of what humans do to themselves or others.  Without motorcycles, mines and machine guns, I’d have very little to do.  On one level I think I shouldn’t complain. Human error means job-security for me.  On the other hand it gets tiring to see the same injuries over and over again.  I find that my level of compassion gets exhausted and all I have left is the sense of profound annoyance and the sheer will that it takes to cobble together some solution to fix what is broken. 

There are bright spots.  Despite the annoyance, it was a tremendous feeling of accomplishment to fish out that little plastic plug.  It is encouraging to see my Congolese colleagues performing procedures that they had not previously mastered. I do still enjoy operating, but it is even more gratifying when I can walk into the room and Charles or Faustin tell me they can handle it.  There are rewards when a patient smiles for the first time, a mother expresses gratitude or a patient who was smashed up walks out of the hospital.  This past week an old man stopped me as I was rushing to finish rounds.  He told me I had operated on him a couple of months ago.  I could not for the life of me remember the case, but he was thankful and proudly presented me with a sack of peanuts, 4 eggs and a live chicken. Despite everything, at that moment, it all seemed worth it, and I felt the assurance that I truly have the best job in the world. 

Please pray for:

  1. Security in this difficult part of the world
  2. Patience as we train Congolese doctors
  3. Comfort and peace for patients who suffer more than we could imagine 
  4. Wisdom as we strive to be good parents and role models for our son Emmanuel
  5. Grace as we deal with various challenges in the missionary community. 


1 comment:

  1. An interesting walk through ICU, praying that the Father will provide you strength when your is low, grace for you labor and supernatural wisdom when tough decisions must be made.