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. 

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.