A Crazy Day

Surgery Rounds (Credit: Katherine Radcliffe)

Do you ever get home, sink into the sofa and just think, “wow, what a crazy day!” Earlier this week, we had one of those days.  When I arrived to the hospital for rounds in the morning, my partner, Dr. Ben, and our rural registrar, Dr. Cindy, were already busy in the Emergency Room. A vehicle had struck three pedestrians early in the morning. One was dead on arrival, the second one had a femur fracture, and the third one (we’ll call him “T”) had bilateral femur fractures, a pelvic fracture, and pulmonary contusions. While Ben and Cindy continued to evaluate and stabilize the trauma patients, I started rounds on the ward.

Bilateral femur traction

Forty-five minutes later, we reassessed the situation. We had 6 scheduled surgeries, a consult to see on medical ward, and three tibial traction pins to place in the ER. I started toward the Operating Theatre while Ben and Cindy saw the consult and managed the trauma patients. When unexpected circumstances like this occur, I switch into determined let’s-get-it-done mode. We flew through the first two surgeries: a pediatric inguinal hernia repair and a skin graft for an upper extremity wound. As Dr. Cindy and I started a laparotomy for excision of a huge (greater than 40cm) ovarian cyst, Dr. Ben was getting the trauma patients situated in the ward in traction. Then, he started a pelvic laparotomy for a large, chronic tubo-ovarian abscess that was adhered to everything in the pelvis. Once Dr. Cindy and I finished our case, we decided there was enough time to do a quick tibial drilling for osteomyelitis before breaking for lunch. The teenager was on the table and we were at the scrub sink when Dr. Nathan, one of our medical doctors, burst into the room. An older man had been chopped in the face by his son, and they were having trouble controlling an arterial bleed near his severed ear. I ran with him to the ER to help control the offending vessel. The man’s ear had been completely transected transversely down to the mastoid bone underneath. The cut also extended to his cheek with exposed parotid gland. Once we got a clamp on the bleeder, I asked them to prepare him for surgical washout and repair while I ran back to our already anesthetized patient in room one. By the time we finished the washout and tedious repair of this man’s ear, I was more than ready for a lunch break; it was 2pm. 

Just as I was settling down for the first bite, Dr. Ben called. Trauma patient “T” had been dropping his blood pressure over the course of the morning and we had been taking turns between cases evaluating and resuscitating him. On admission his abdominal ultrasound showed just trace free fluid, but now on repeat scan he had a large amount of fluid in his abdomen concerning for an uncontrolled bleed. Dr. Ben was taking him to the theatre for emergency exploration. As soon as I finished my lunch, I popped my head into the theatre, they were getting the patient positioned and anesthetized. Then Dr. Ben came in with a look of disbelief on his face. My last patient, the old papa with the ear laceration, had swallowed his oral airway! He was coughing and choking in the recovery room. The offending object could not been seen with a laryngoscope, so I took him to room two for an exam under anesthesia. 

Once his airway was secured, we looked in his esophagus with a rigid scope, but the object wasn’t there. It must have passed into his stomach we surmised incredulously. An EGD showed the stomach was completely empty. Could this large curved plastic mouthpiece have passed through his pylorus?! Upon reporting our findings to Ben, a student in his room spoke up: papa had spit out the oral airway and it had been thrown away. He had been choking on his own spit this whole time! Meanwhile, Ben had removed the ruptured spleen, repaired the bladder injury and packed the pelvic hematoma in the trauma patient. Our last case was a washout and debridement of an infected wound. This young lady had her foot nearly amputated in a chop-chop incident 2 weeks ago. We attempted repair but the wound got infected. Thankfully, the infection appears to be superficial and there is still blood flow to the distal foot, so we hope it will be spared.   

Finally, exhausted, we headed home. But before we could get there, Dr. Nathan called from the ER. A man had eaten a large piece of meat and a bone was now stuck in his throat. We fished it out with some forceps and were surprised to find not a fish bone or a little chicken bone, but a 3x3in sheep bone! No wonder he was having trouble talking.

As I returned home again, exhausted, but strangely energized by the interesting case, I thanked God for providing the right people and resources to care for all our patients today. It was the busiest day since I've been at Kudjip: twelve procedures in one crazy day.