Usually I blog around 5:30 when all the cases are done and we have wrapped things up for the night. It's currently 7:45pm, and we still aren't done. They don't need me in the OR because the case we currently have is so sick she needs two surgeons... But, let's start at the very beginning. A very good place to start.
We started the day with our 6:30am walk again today, but this time we went to the river instead of the mountain. The walk was a fabulous dichotomy of beautiful and ugly. The streets are filled with delightful people staring at us and waving. The walk had to take a slight detour when we had to negotiate around a man sitting in the path butchering a cow with a machete. Lots of people were standing around, talking, waiting for their piece. I have pictures for those who are brave enough to look.
The path to the river was through banana trees and planted fields with gorgeous mountain scenery all around. The path itself was bordered the entire length in a 3 foot pile of trash. Some burning, some not. Goats and pigs grazing on it. Women at the riverside were doing laundry and cleaning themselves... we did not touch the water, of course, given that this could also be called 'cholera central.'
We got back, had some breakfast, and started with what was supposed to be a quick, 'wrap it up' kind of day. One hysterectomy, one hydrocele (that I actually performed), two hernias, a breast fibroadenoma, and a few lumps and bumps seen in clinic. We heard just before lunch that there was an appendicitis in clinic, so he would be an add-on.
After lunch, the drama began. The appy was a 70 year-old man. He signed his consent in the OR and then had his spinal anesthesia. This is when we learned the people who came with him weren't his family (as previously believed), and they were insisting we don't operate. You see, here there is no food service. This is no significant nursing. So you have to have someone who stays with you and brings you food and water, someone who will take you home. And the people screaming outside the OR said they wouldn't and that we were just going to kill him on our table.
Well, then it turns out they are his neighbors. They don't want to get in trouble if something bad were to happen, so that is why they were refusing care. Since they weren't family,AND none could be found, AND the man was going to die without surgery, we went forward (his own consent not being worth much).
This is when Leslie comes into the OR and announces that over in clinic, a woman who had had an abortion yesterday came into clinic bleeding. They attempted a D&C (uterus clean out) in clinic, but instead ended up with small intestine coming out of her vagina. And we only have one OR that can do these serious cases.
So, we dive into the appendicitis case at 2:30pm hoping it goes quickly, knowing the woman could go south very quickly. Steve and I got into his belly, and it initially looked like a ruptured appy that has been there for a while. Lots of scarring, lots of nasty looking tissue... but then we found ourselves inside the cecum, i.e. into open bowel. After looking around some more, it turns out he has metastatic colon cancer that had ruptured. We end up having to widen his incision and do a right colon removal (i.e not quick at all). By the time we have his colon out, his bowel put back together, remove another met that is about to perforate, and sew him back up, it's 6pm.
Needless to say, laying in a hospital in Haiti with intestines hanging out of your vagina for 4 hours isn't really good for a person. Steve and Leslie got into her belly to find a hole in the top of the uterus from the botched abortion/D&C, and 5 feet of dead small intestine (half in, half out). They have just about wrapped up the bowel repair as I type this. Then they will begin her hysterectomy. She has 5 kids. Her husband is out of the country right now.
So, we finish with a bang. And tomorrow we hand off these super sick patients to the incoming team from North Memorial with a piece of paper handed off at the airport in Cap Haitian. We still have the seizure lady, who still doesn't recognize family members but does recognize our interpreter. There is the guy who has his suprapubic catheter and will just wait for the urologist to come fix his prostate. And lord only know what could happen in the next twelve hours before we leave.
But, what I do know is that this is my last post from down here. I will wrap this up, check the OR, and start packing. Thanks to all of you for your well wishes and good thoughts. Steve summed this whole week up with 4 statements: 1) I love it, 2) I hate it, 3) I want to come back, 4) I never want to come back.