Surgery!

I think that today has provided me with sufficient evidence to support my theory that surgery is incredible. There is currently a Dutch surgeon visiting/working at the private hospital near Kisoro. The surgeon had met us when he was visiting Kisoro and said we (Maddie, Sarah and I) were welcome to shadow, so today we took him up on his offer. Our day began at 7:45 when we left for the hospital. After waiting outside of the surgical theatre for 15min we were greeted by the surgeon and met up with the Dutch students and Ugandan surgeons. The first case was a direct hernia repair. There is no laparoscopy here so it was an open procedure and they do not use mesh because it increases risk of infection. Instead they use absorbable sutures. The surgeon pointed out relevant anatomy and answered our many questions. Next up was a recurring cyst that I learned was due to abnormal embryological development of one of the branchial/pharyngeal pouches (sorry embryology is NOT my thing so I don’t know which precise arch). Anyways, the patient had had recurring cyst formation due to poor surgical technique. I learned that most surgeons remove only the cyst. But, there is also a tract that is where the fluid is draining from and so this surgeon found this, traced it back to its origin in the hyoid bone, cut the hyoid bone (no adverse consequences from this, I asked) and removed the cyst with the tract. The patient should never have this problem again. We briefly walked across the hall to the other OR and saw the end of a Caesarian section. The next case was a young boy who suffered from osteomyelitis. Treatment here involves drilling holes into the femur and trying to find where pus instead of blood is what seeps from the hole. Then the surgeon used a chisel to open up the bone in the areas where he found evidence of infection. The patient will have to stay in the hospital for some time to allow the wound to drain. After this we watched one surgeon apply casts to a baby with clubbed feet and another surgeon drain an abscess in clinic.

After this very full morning, the Dutch students took us to their compound to eat a quick lunch and then we got back to the OR. A woman had come to the hospital with a profoundly distended abdomen. It felt firm when I palpated. After trying (unsuccessfully) to relieve the pressure using less invasive methods (sorry, I will keep this blog non med friendly so we won’t go there) the surgeon decided to open her up to see what was causing this problem. He made one long vertical incision from below her belly button to between her ribs and then he placed his arms in the incision and pulled out what looked to be an inflated balloon. IT WAS HER LARGE INTESTINES! I was informed that some patients have long colons and these, for reasons yet to be discovered, may twist leading to obstruction. So the surgeon unwound the colon, used suction to remove the air, and placed it back in the cavity. He added some sutures and it was done. The woman had gone from looking 9 months pregnant to very thin in a matter of minutes. I have never seen anything like it!

We thought after this case we were done for the day but someone came in and announced that a boy had been hit by a motorcycle and that he had an open tibial fracture. We decided to stick around. I am glad I have shadowed in trauma surgery at Jacobi because I have seen some pretty gnarly things. This though was a pretty profound injury and the boy required a blood transfusion when his blood pressure became too low. This surgery took the most time and we ended up leaving right after bandages were applied at around 7:30pm.

It was a very long day. But, while watching the surgeon work I had a lot of time to think. Here is some of what goes on in my head: Surgery is incredible and you can fix so many things! Surgeons also deal with very sick people, and sometimes you cannot fix everything. Today, when we were walking through the SICU, I learned that two children were comatose after being involved in two separate motorcycle accidents. While we were looking at another patient in the back room, one of those children died. I was not at all involved in this patient’s care and I still felt devastated. I actually think that when you are a surgeon, unless you are an OB/Gyn and deliver babies, you are seeing your patient on the worst day of his or her life. They come to you in pain, you and your scalpel inflict more pain. But sometimes, in a short period of time, you can have a profound impact on that person’s life. I watched this surgeon today save a boy’s leg and his life, cure several conditions, and provide interventions that will improve quality of life. And I was there for LESS than 12 hours! So, while I have a long way to go in my medical education and I really have no idea what I plan to do with my career, I do think I will be drawn to an area of medicine where rapid results can be achieved.