Lesson of the day: Brush your teeth!!

This was originally supposed to be a funny post. We've had several people come in with dental abscesses, and I always joke with the OR nurses and ask them "What have you learned today?" To which the answer is "Always brush your teeth!"

The 1st time I ever performed CPR on a live person (not the dummies we practice on) was a guy who came in for a dental abscess and stopped breathing on the table. Luckily, it was only for a few seconds and we got him back.

Then we had a lady who had a track of pus going all the way up her cheek and to her skull above her ear. We opened it up and pus just kept coming. Her aponeurosis was necrosed and we had to dissect it out. This is a dental abscess, and here I am, looking at her cranium!! She's an elderly lady, and I was actually afraid she wasn't going to be able to kick the infection. Amazingly, she's doing well.

However, yesterday we had another dental abscess. Young, otherwise healthy female. Huge amount of pus. She aspirated. She desatted, and try as we may, she just kept going south. We were trying to suction the pus out of her lungs, and giving her O2, but nothing seemed to help. After about 15 minutes of having O2 sat between 60-70% and a heart rate above 150bpm, she arrested. I jumped on the table and started doing compressions. I looked at her eyes and her pupils were fixed and dilated. I knew her brain had been without oxygen for too long. She died.

(Here is Dr. Scott's blog about what happened, in case you want more details: https://gardners2koza.wordpress.com/2016/02/25/death-in-the-or/ )

So what was going to be a funny post about the importance of good dental hygiene, became a tragic post about the 1st patient who I've seen die on the table. Because of a stupid dental abscess. It seemed totally surreal. I'll never forget the look on her mother's face.

So if you're reading this, thank your lucky stars that you have access to a dentist, a toothbrush, and toothpaste. Make sure you use it. It may quite literally save your life.

(The pictures below are from the 2nd case described, the elderly lady with pus tracks going up to her skull.)

During the procedure

During dressing change

Call me surgeon!!

I think there comes a moment in every med student's life, when they feel like their dreams are coming true, that they're in the right path, that all the effort (past, present and future) is worth it.

My moment happened when I performed my first surgical procedure (minor!) on my own, from beginning to end. I was supervised, of course, but I did everything. Local anesthesia, incision, disecting the lipoma out, suturing. It was removing a lipoma from someone's thigh, so nothing transcendental, but it was awesome. And it was a pretty big lipoma too!!

I feel like a surgeon. Of course, I have *many* years of hard work ahead before I am really a surgeon, but I'm getting there.

Here's a picture of me, grinning from ear to ear, with the lipoma I just removed!

It's not only about the medicine... just mostly!

Life in Chad is hard, in particular when you work at a hospital. So once in a while, you kinda have to get away. The first time I was here, I went to Gore, a city in the south. This time, I went to Bere, a little to the northeast of Moundou (where I work). There's a sister hospital there, from the same organization, so they also have volunteers and American doctors (3 of the!) It's a bigger hospital, so more volunteers!

We had a feast at a local woman's house, played lots and lots of games, laughed until tears were running down my face and I could barely breathe, and even got to ride on a donkey! Oh yeah, there was some surgery too. :)

Pictures!!

 Traditional Chadian Boule

 There was SO MUCH FOOD!!

 You put everything in a platter and people eat with their hands, from the same plate.

 Me riding the donkey!

 Selfie in the back of the pickup on the way home!

After the pickup stopped...

There was also a little surgery... :) Saturday morning Dr. Roland asked if I wanted to scrub in on a laparatomy with him. Of course!! It turned out to be a bowel resection. The guy had about 2 feet of dead bowel inside, about to rupture. Luckily, it didn't, and we were able to repair it cleanly. He'll do fine! And I got to do my first subcutaneous sutures!!

Dead bowel

I was concentrating on my sutures!

Not bad for a first try, hey? 

It was a good weekend. Which I finished by coming back at 10pm, on my own, taking a moto-taxi after dark for over an hour, plus a shared taxi car ride for another 2hrs. Crazy, I know. Kind of exciting. Kinda stupid. I made it though! :) 

Death

A little bit of truth: February is usually a hard month for me. That's the anniversary of my father's death, and even if I'm not thinking about it, it's somewhere in the back of my mind and makes everything tinged with a little sadness.

Being in Chad is hard. Watching people, and specially kids, die for stupid reasons, is hard. There's only so much I can take. All the scrubbing in, and doing procedures is awesome, but everything else kinda eats away at my soul, until I just want to leave. That's why when people ask me if I want to be a full time missionary doctor, my answer is always no. I will continue to come every year, maybe for a few weeks, but I think 2 months is my limit.

Friday afternoon we were leaving to spend the weekend at our "sister hospital" to visit and maybe relax a little. Friday morning a child came in with severe burns. Accident happened 3 WEEKS before. She was unconscious and barely breathing. Both feet and one hand were necrosed. We put her on O2, but there was nothing much to be done. She stopped breathing a few minutes later. I don't even know her name. I cried.

Then we left for the weekend, and I actually managed to relax, met some cool people, laughed, and forgot everything for a minute.

Came back late Monday night. Exhausted. Wanting my bed. Found out Adamah died on Saturday. (My burn patient). Apparently she just quit breathing. Just like that. Her body gave up.

I wasn't here. I didn't get to say goodbye. I didn't hold her hand during her dressing changes on Friday, and I feel guilty about that. I didn't do enough. I really thought she was going to make it.

I have 2 more weeks in Chad. Pray for me. 

Prayer request /positive vibes (if you don't pray)

We have a burned lady patient, who had 3rd degree burns on her thighs, buttocks and lower back. Really bad. You can see pictures here (not for the faint of heart) and read more about it here.

She was at home for 6 weeks after the accident (her house caught fire and her dress caught fire as she was fleeing), then she came to us and has been here a month. Not in a state-of-the-art burnt unit, with filtered air, sterile everything and no contact with the outside world (full of germs). No, she is in a filthy building with 10 other patients in the same room, laying in filthy sheets, with flies and mosquitoes, dirt and grime.

She is our miracle lady, somehow still alive, not infected, not septic.

However, she is getting a pressure sore on her tail bone and if it gets necrotic, that's harder to heal than her burns.

She also had malaria and didn't eat/drink for days because everything she'd swallow would come back out.

She's doing better now and I've decided to start "force feeding" her. I bring her food and don't go away until she's eaten. But she's going to need a lot of food to regain her strength and grow all the new skin she needs to grow.

Someone said it would probably be better for her to die now, because they couldn't see her surviving and it was just more suffering until she died. I am determined that she will live. She would have died already if she was supposed to die. She's fought this far. I'm gonna help her fight the rest of the way (or until I leave, at least).

Please pray for her. Her name is Adamah.

Homesick

This isn't normal. I am *never* homesick. There have been times, when traveling for long periods of time, when I felt tired of being on the move and wanted to take a break, or times when I wanted to leave the place I was at. But never had this longing to *go home.*

Maybe it's because I'm growing older, or maybe it's because I feel like I have a real home to go back to. I don't know.

Being homesick is weird. Missing home is weird.

I'm sure it's just because today was a generally blah day, and I'll get excited again tomorrow.

As a side-note, I learned the 12 cranial nerves + their function and regurgitated them out every which way while in the OR today. At least in that respect, it was a productive day.