Tuesday, September 27, 2011

Week 1 Thursday

Like Tuesdays, Thursdays are our other primary surgery day. We had an ambitious schedule of 7 cases which I knew we were not going to get to all of them. Instead of making patient numbers 6 and 7 wait around all day without eating only to not have surgery, I went with the long term nurse volunteer, Lynn, and rescheduled those patients and sent them home. The evening before an elderly woman with a few day old femoral intertrochanteric fracture was transferred to our hospital for definitive treatment and so she was also added onto our schedule providing that her uncontrolled hypertension (180s-200/100-110s) was lowered. To try and accomplish as much as possible of our ambitious schedule, we had planned to skip the morning meeting and start surgery right at 730. But like all things in Haiti, starting on time never goes as planned. The local general surgeon had a tumor removal that morning and a woman came in for a C-section so we no longer had an OR to work in and instead of starting at 730, we started our cases between 930 and 10. Oh well. By the time we took a break for lunch, all we had accomplished were two cast changes - one for a child with clubfoot and the other for a child who had been badly burned a few years ago and developed a severe flexion contracture making him unable to walk. When he was brought to the hospital for his initial surgical correction, his parents abandoned him at the hospital, leaving him as a functional orphan. Since that time, he had been staying in the long term rehabilitation housing and was being taken care of by the other adult patients also staying in that housing. 

After lunch, our next case was a middle-aged woman with untreated metastatic breast cancer who had developed bone metastases in her left femur and right proximal humerus leading to pathologic fractures. Her femur had been fixed the week before and in order to discharge the patient and free up a hospital bed, she needed to have her humerus fixed. There is rumored to be chemo and/or radiation available in Haiti, but we are not sure that even if the patient could pay for it that it actually exists. Her proximal humerus was completely eaten away by tumor and since we had no humerus rods available, a Kuntchner nail was used. Kuntchner nails were developed by the Germans during WWII in order to fix femur fxs so that pilots and drivers would be able to use their legs to drive. On a side note, this patient also had developed a vaginal infection while in the hospital and since I happened to be the closest to my Ob/Gyn rotation, I was the “expert” of our group with respect to treating vaginitis. So in addition to fixing her humerus fracture, we also cured her vaginitis. 

At the end of this, we had planned to take the femur intertrochanteric fracture for fixation since no PT was available over the weekends. Unfortunately and fortunately an acute abdomen presented to the hospital and the local general surgeons needed our room for an exploratory laparotomy. Only one anesthesia machine is working in the hospital so any patient that needs GET anesthesia has to be in the ortho room. So instead of operating past midnight for a second night in a row, we finished at a reasonable time and left the hospital for the first time all week and went to our favorite local place, the Auberge de Quebec, for pizza and Prestige!
walk to the Auberge

pathologic fx from bone mets

fixation with K-nail

LLC on boy with flexion contracture

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