A Week of Firsts

I just finished my first week of surgery here at Tenwek. It has already been a great experience. I've seen some amazing medical cases - things you may never see in an entire career in the States. Here's a quick run-down (get ready for some medical jargon):

I helped repair my first inguinal hernia, my first femur fx ORIF with a SIGN nail, first supracondylar fracture with pinning, several pediatric burns ranging from 8-45% TBSA, so I've gotten to do some skin grafting.  I've hung out with a urologist for a while, we've done some cystoscopy, suprapubic caths, retrograde urethrogram, my first bilateral orchiectomy, rectal biopsy (to dx Hirschprung's), repair of anorectal malformation, and a vesicovaginal fistula repair.  I also helped place my first VP shunt.

I'll mention one case in particular, that took place on the operating table you see above.  On Thursday I was called to see a lady in Casualty (the ER) who had been to another facility a week prior for a D&C after a spontaneous miscarriage.  She had been fine until a couple days ago when she had sudden onset abdominal pain and vomiting.  She had actually been to our ER at Tenwek both days previously but was sent home.  This day, she just looked sicker and the surgical resident that saw her thought we should do surgery.  I examined her belly and wasn't impressed.  She reported mild tenderness upon palpation, but looked unphased, and had no rebound or guarding.  She looked exhausted, but it didn't look like an acute abdomen.  We debated some possible causes of her pain, from ascaris to typhoid, and decided the most likely explanation was a complication from her D&C, which meant we really needed to look inside anyway.  So we decided to take her to the theater (the OR).  We prayed with her before we started, something we do before every surgery, and opened her up.  This was another first for me: exploratory laparotomy.

What we found was a week's worth of bowel in her abdomen.  Not only had the outlying facility perforated her uterus during her D&C, they perforated her small bowel as well.  We repaired the uterus and the small bowel and irrigated with 10 liters of saline.  Her bowels were swollen and inflamed and coated with fecal material.  We even identified some of the local leafy plants that are commonly eaten here.  After we closed the abdomen, we started her on the broadest spectrum of antibiotics available here.  So far, so good.

Thinking about the mess that was inside her belly, I'm amazed at how unimpressive her physical exam had been.  This serves as a reminder to me of the strength and resilience of the people we are caring for here.  I'm thankful we went ahead and decided to take a look.  I'm not sure what the outcome would have been if we had waited any longer.

Please continue to pray for us, and for the patients we are caring for.  Stories like this one take place every day.  There is no shortage of pathology here at Tenwek.  But as Jesus said in Luke, chapter 5, "It is not the healthy who need a doctor, but the sick."

At the end of that verse He says, "I have not come to call the righteous, but sinners to repentance."  Jesus, the Great Physician, can heal not only the body, but most importantly, the soul.  Please pray that I won't be the only Physician that my patients meet during their stay here at Tenwek.