Irene

For those of you who follow my blog, you have read about Irene before, even seen pictures of her giant wound, in the place where her right leg used to be. 

Irene was my first challenge. When I arrived in Chad, she still had her leg, but it was so infected, she was getting septic. The day after my arrival, she had an above-knee amputation. She still had a pocket of pus tracking even further up her thigh, so every morning, my job was to literally stick my entire index finger all the way up that pocket of pus, dig around in it, clean it out, irrigate, and dress the wound. With absolutely no anaesthetic. You can imagine the amount of pain that caused her. You can imagine how hard it was for me to do it, hearing her saying the then unfamiliar words that sound like "Ma cuilliao".* I didn't know what they meant, but I could guess... 

Day 1 post-op:

Every day, I would start the day with her dressing change... and I could see the progress: 

You can still see the layer of subcutaneous fat, but granulating tissue is starting to form. 

Here you can't see the fat layer anymore, and the wound is just starting to fold in the middle. Notice that the pocket of pus on the left is still there...

This was the first time she ever smiled at me, the first time we got her up and walking (already 3 weeks ago). 

This was the wound last week, already much smaller, and the pocket had no pus in it and was only about 3-4cm deep. 

This was Irene and I yesterday, when we were out practicing with her new crutches. 

Today, she is getting her leg sutured shut. The wound is clean, and small enough that we can join the skin on both sides. 

It is incredible, the healing power of the human body, and the resilience and strength of the human race. It is exactly 1 month since her amputation. She will be going home soon. 

I will miss her, but I'm glad she is healthy and even happy, as you can see from the big smile above. 

She might forget me. I will certainly never forget her. 

Right before closing...

Closed!!!! 

It's a happy day for me. And for her. :) 

*"Ma Cuillao" is an expression of extreme suffering in Ngambaye, there is no exact translation. I have become quite familiar with those words... 

A day of firsts...

**WARNING** Graphic pictures, not for the faint of heart!!!

Today, in the middle of rounds, they bring a man in carrying him in a very awkward position, sort of vertical... When they passed by where I was standing, his eyes were rolling backwards and he seemed to have no muscle tone. Apparently he had fainted when he went to the bathroom... They put him on the bed as I finished the bandages on another patient. I immediately went over there, and the Samedi, our Chadian doctor had just stopped looking for a pulse. He was gone. I grabbed his wrist, nothing. Looked for his carotid pulse, nothing. He was still warm. 

The daughter let out a scream, almost fainted herself, and walked out crying, accompanied by another family member. The wife stayed there, wailing and touching him, and covering him, and touching his face... 

It was heart wrenching... 

It was the first time I actually saw someone die. Not even my own family members, (my dad!), I had not seen them after they were dead. 

I have seen dead bodies, cadavers in Anatomy Lab, but it is **really** not the same thing. They're cold, bloodless, and feel like rubber. It's hard to think of them as humans.

He was warm. It's hot here, so he was a little sweaty. He had come in for a hydrocele and had seemingly nothing else wrong with him... 

There are no autopsies here. He just died. I'll never know why. Maybe he had a stroke, or a pulmonary embolism... who knows...

People here seem to have coagulopathies, either they clot all the time, or they bleed and bleed and bleed. Probably a product of their poor diet... 

They also have cancer. Giant cancers. They let it go on for too long, and usually come in when they have giant fungating masses that smell awful and look even worse... 

That's supposed to be a knee. There's nothing that can be done, except amputate above the knee, but at this point, it's certain that it's in his lymph nodes and has spread to who knows where. There are no CT scans or MRIs here. He's going to die. We just don't know how soon. 

The surgery was gruesome. I had only seen a big toe amputation (diabetic foot) and the last part of an arm amputation, but I was scrubbed in and holding his leg from beginning to end. 

Separate the muscle from the bone 25cm below the hip joint, pull back the flesh to expose the bone, bring on the electric saw...

Those are my hands holding his stump.

Did I mention he was moving? He had a spinal block and ketamine, but apparently it was not blocking his motor functions. Thankfully, it *was* blocking his pain receptors, so he couldn't feel a thing.

It was the saddest surgery I've ever seen... 

I had to leave and go make myself some coffee... It was a really rough morning. 

In the afternoon, there was a hernia repair, no complications, a simple operation... So I scrubbed in as the first assist! 

That was awesome. I had my fingers inside this lady and pushed her intestines back into place. It made me realize that in the OR, when you're focused on what you're doing, you forget everything else. For a little while, I forgot about the man who died, and the other man who lost his leg... 

I guess I understand why some surgeons say the OR is their sanctuary... I think it might be mine too...