The guy with three knees

I'm sure you think it's not possible to have 2 legs and 3 knees, but let me assure you: it is.

This guy comes to us with a 2-year old tib-fib fracture, not consolidated, and he's walking. He literally had an extra joint on one leg, the ends of the bone had somehow calcified and settled like a joint. It was incredible. (See pictures!!)

We could really make a difference in this guy's life. We could give him 2 straight legs and remove the 3rd knee!! 

So after spending a lot of time removing a lot of scar tissue and calcifications, we were finally able to put the two ends of the bone together, and Dr. Scott put an intra medullar rod for the Sign-nail repair.

It was a looong surgery, and there was a lot of pulling, pushing, hammering, etc. Bones are really freaking solid stuff!! It's not easy to break off the calcifications on the wrong parts. Again, Ortho is not my thing, but the fact that we could really reshape his leg was fascinating.

I'll stop talking and let the pictures tell the story. :)

Look at that articulation!

It was not easy to bring the ends of the bone together and straighten it

So much metal to choose from!! 

That's the intramedullary rod 

(Sign nail) going in

You can kinda see the rod 

going through

X-ray before operation

Like a kid in a candy store

Remember that episode of Grey's Anatomy when Christina enters the ER and says "it's like candy, but with blood, which is so much better!"?

Well, that's kinda what I felt today, but my specific kind of "candy" are sharp objects, like needles. I love drawing blood, injecting meds, putting in IVs, etc. I'm also really good at finding veins.

But today, I got to do something even cooler: I got to do 2 spinal taps! Seeing as I plan on doing neurosurgery, this is an important skill to acquire, and I did both perfectly. 2 Champagne taps!! It was awesome. Both were for hernia repairs.

What isn't my surprise when Dr. Scott hands me the needle driver and tells me to close this guy's skin! I thought he was joking, but since he was handing me the instruments, I realized he wasn't.

So I did my 1st suture on a live patient today. I had practiced doing knots and suturing on an amputated leg, but now I actually sutured someone's skin!!!!

This might be all silly to you, but I couldn't stop smiling afterwards. Remember that I only just finished 1st year of med school, nobody gets to do this stuff this early. I am so lucky!!!

To finish off my day, I changed the a supra-pubic catheter on another patient.

All in all, this was an awesome day!! :)

Pus

We had a couple of really long, full days. One of those days, Dr. Scott had to cancel consults because we had too many operations, a couple of which were urgent. As the name of this post suggests, there was a lot of pus involved.

We had one elderly man with an old femur fracture that had only a small hole on the skin. What was weird was that he was very skinny, and his other leg was very thin, but his broken leg had a huge thigh. Dr. Scott made an incision starting from the hole and as he widened it, pus just started pouring out. We suctioned about 2 LITERS of pus from this guy's thigh. As you can imagine, there was not much muscle or bone left, it was just mush. How in the world he wasn't septic and dead yet, I have no idea.

So we called the family and said there was no way to save the leg and asked if they were ok with an amputation. Well, the patient himself, who was semiconscious*, heard it and said he did NOT want an amputation. So we closed it back up and wheeled him out to get ready for the next patient.

But now the family talked to him, and explained that really, there was no leg to be saved, it would never be functional again, and on top of that, he was going to get septic and die. So he agreed to it, and we had to take him back to the OR.

Then, we had a guy come in with a huge dental abscess. His family almost took him home, but thank goodness, they didn't. The abscess was so big, once he was anesthetized, his muscles relaxed and it actually blocked his airway. He stopped breathing for a moment and I actually had to do CPR while they secured his airway with a nasal tube and administered O2.

Again, Dr. Scott made a small hole and pus just started pouring out. It's incredible!! I can't imagine how he could take days and days of pain before coming in!!!

So today I got to do 3 things I had never done before: made a skin incision and superficial suture on a leg (the amputated one), and did CPR on a real person (not the dummies we use in class).

What a day!!!

*our anesthesia is a combination of epidural, ketamine and diazepam. Sometimes the patients are knocked out, sometimes they're awake, talking, sometimes even moving. We have no respirator, so we cannot do full narcosis.

Before amputation

After amputation

Correction

A lot of people who read my blog say things like "you're a hero", "you're a saint", and somebody lately said I was the closest person to Mother Theresa they've ever met.

Well, let me tell you something: I am none of those things. Yes, I am helping people, and yes, I love knowing that my work makes a difference in people's lives. But I am *not* sacrificing myself by being here. I like it. I learn SO MUCH, and I get to see incredible conditions that I would never have the opportunity to see elsewhere.

Plus, I am one of those crazy, insane people, who finds the inside of the human body fascinating. Think about it: you have a body for 50, 60, 70 years, but you only get to see the inside of your mouth, nothing else. To be able to see inside the body, you have to be a serial killer (which I'm not, rest assured), or a surgeon. I am on my way to becoming a surgeon, but I still have many years ahead before I can call myself that. And as a lowly medical student, even if you are lucky enough to get into the OR, you usually don't scrub in, which means you're at least 3 feet away from the table and can't really see much.

Here, I get to scrub in to 3-4 surgeries **every day**!!! I have had my hands inside the abdominal cavities of several people. My index finger has found a hole in someone's small intestine. I have touched several femurs, tibias, humerus, and held them in place while the surgeon drilled through them. I get to see and touch everything, and it is *awesome*!

So basically, I'm here because I love medicine, I am curious about the human body, and I want to learn everything as fast as possible. I've wasted too much time already, and being here gives me a huge advantage.

Please don't confuse my excitement and curiosity for sainthood. I'm just a sinner like everyone else.

Cancer

I mentioned on the last post that I was overwhelmed and tired because Tchad is hard and sometimes it gets to you.

Adorable 9-year old girl, Caroline, cones in carried by her dad. Skinny kid, but not malnourished, just normal skinny. Then she lifts up her skirt, and her thigh, just one of them, is larger than mine. It's a hard mass and it hurts when we move/touch it.

The only thing to do is to amputate her leg. So we schedule surgery for the next day.

We get into the OR and I'm already sad enough as it is, but this thing was scary. We only had one unit of blood available for her, and there were massive veins you could see through the skin. Crazy.

Upon further inspection, her lymph nodes were swollen in the arms, neck and groin, which is a good sign the cancer had already spread. We have no image studies (except x-rays and even that has to be done at the public hospital) and no pathology. No way to know for sure.

Dr. Scott makes a superficial skin incision, just a couple of inches long. And it bleeds, it bleeds, it bleeds. He tamponades it with a wad of gauze, and it immediately soaks up through the gauze. He presses it for a while and it just keeps bleeding. Eventually, the bleeding slows down enough, that he can suture it shut. It was only a skin incision!!!!!!

There was no way to go deeper. She would have bled out in minutes. There was no way to amputate. Even then, the cancer has probably metastasized to several places. We had to send her home. There are no treatment options in Tchad.  

We also had an elderly man with a giant mass in his prostate, also inoperable. And a young woman, with a baby actually breastfeeding while she was examined, with a giant mass on her face, probably a tumor of the nasal passages, which will erode her sphenoidal bone straight into her brain.

And there was a middle-aged woman with a lump on her neck. Lymph nodes swollen all over. Checked her abdomen, and she had palpable masses throughout.

Basically, cancer sucks. And there's a lot of it here, I don't know why. Little kids, adults, elderly people. And they *always* come when it's giant and you just can't do anything anymore.

The pictures below are of Caroline's leg.

Compare the diameter of her two legs

Notice the size of the veins

Tired...

Feeling overwhelmed and tired. It's been a tough couple of days here. Lots of emotions, and it's not likely to get better in the next couple of days. I'll write a proper post later, but to make a long story short, we had a 6-year old girl with inoperable cancer and had to send her home to die. In pain.

Then, the hospital administrator was robbed after leaving the bank with a substantial amount of cash.

Life is just complicated in Tchad. Sometimes more than I can handle...

Pray for us.

Miracles (photos)

Photos from the burn patient. It doesn't show her back and buttocks, but it gives you an idea.

This was the skin graft 

done on January 13th. 

This was taken on February 5th, about 3 weeks after the skin graft. You can see a small layer of fat starting to form, but there's the pressure sore in the middle...

This gives you a better idea of the extent of her burns...