FEB-B-5
FIRST OPERATING DAY IN BETHEL HOSPITAL
AT MALAYBALAY, BUKIDNON, MINDANAO
Feb. 11, 2002
General, general surgery! I am at work in a well-equipped mission hospital with good staff and an array of cases, yet feel that it is something less than heroic, since it is hard to feel that I am making do with whatever I can improvise, when almost anything might request is furnished! I did have a chance to teach two thyroidectomies for large goiters to Susan, the general physician who is here on the staff and interested in learning more about OB/Gyn. Then, after a two-day trip from Leyte, came Dr. Ragon Espina from the second of three satellite clinics set up by Bethel Hospital 25 years ago. He had to take two boats from the island on which Macarthur landed in returning to the Philippines (there is a shrine to him there and also a whole town named after him) coming through Cebu to arri9ve here, for the specific purpose of exposing him to the teaching of a professor of surgery to get him ready to complete his testing for the Philippine College of Surgery. So, the rest of the day, I assisted him in a variety of general surgery—one of which looked like “de ja vu all over again,” for me.
The day started with devotions in the Bethel Baptist Hospital Lobby, so that everyone knew what they were doing here. Allen took his usual role in delivering the message, as the administrator of the hospital led the introductions. She is Ruthie, a real dynamo, married to the chief of the grounds, Donnie, and how every thing works—a couple with whom we had dinner last night. We had discussed many things including their close relationship with the family of Martin and Gracia Burnham, who are now approaching one year in captivity as hostages of the Abu Sayyaf (Sword of Allah.) After a very flattering introduction for what I meant and could do based on what they guessed I carried around in my head, they broke up into their “prayer triplets.” Mine was actually a duo, with the business manger who wanted to know the loved ones in my life, and then prayed for Donald, Michael, my grandchildren, sisters and Virginia, my special love, on this week which will include Valentine’s Day, and hoped they would know that I did not love them less, but rather more, because I was so far away.
I did the first one with Susan, showing her how it could be done, and despite the size of this one (at first said to be “unnecessary surgery” by Holly laughingly, since it was the size of an American gland from the outside—about a 100 gram enlargement--) but she had to eat her words as I delivered the hidden submanubrial part up out of the chest which was three times larger still. [For reference, the average adult normal thyroid weighs 18 to 25 grams, and we have been removing scores of goiters 10 to 100 times that size.]
Then came Ragon Espina, who had an amazing story. He graduated from medical school at Ilho Ilho and went out as a partly trained surgeon to the peripheral hospital where there are two other physicians—his (now) wife, a pediatrician, and another doctor who is a partly trained gynecologist, who are left in charge of the Leyte small hospital mission station as he has come here for what “training” his time with me is officially constituted. He was supposed to sit the exam for the Philippine College of Surgeons on April 8, but a family incident happened here in the Philippines on December 4. He is one of eight children of deceased parents. Five of his siblings are in the US, including a GP in Michigan and three nurses. He and his brother, a prominent employer in the electrical business in Manila, were the success stories of those who had graduated and were still here in the Philippines. But, an altercation occurred at his brother’s work and he was stabbed and killed by an employee, currently in custody. So, Ragon has been derailed on his way to getting a further credentialing for work either in the mission hospital where he is now, or in more ambitious hopes he has. Furthermore, like Allen Mellincor, he married late, at age 37 and now has a four-year-old son, as Allen married Blessie after she originally turned him down, at age 35, and they now have a 9-year-old son Paul. So, each of them are in transition, since Allen seems to be going toward a full time career in evangelism, and Blessie, who was a veterinarian, is studying now to become a nurse! This may be working her way up the phylogenetic scale, but hardly by any other criterion a smart progression.
I assisted him in the performance of the first thyroidectomy of his life, and despite a great number of demurrals, preferring to assist and watch me, he did a competent job with a bit of heavy handed help, so that each thyroidectomy of the morning took less than twenty minutes. See! It is true about “Just like riding a bicycle!”
We also had a small boy with a large cystic hygroma of the neck, which was on the OR schedule, but I convinced them not to operate on him, since it would endanger him, be incomplete and recur several times anyway. So, under anesthesia, I aspirated several hundred milliliters from the two major loculations of the cyst, and then injected each with a mixture of fifty percent dextrose with lidocaine in the mix. The former is an osmotic shock that should destroy the secreting lining of the cystic hygroma, and the latter is a local anesthetic that should prevent the stinging of the mild inflammatory reaction that should get the cell lining of the cysts to stick together and obliterate it. So, this child was spared an operation for what I viewed as a superior and less invasive treatment.
We broke for lunch—a rather heavy and good fare, not according to my usual caloric intake and certainly not when I have not been running. I have expressed an interest in getting back, somehow, to running, and have also learned that Janet Molina’s brother is the manager for the wildlife preserve here on Mount Kilanglad where I might hike up a stretch of climbable mountain and see the Philippine eagle—the monkey eating raptor that is the national bird symbol. It is said that we might operate only half a day on Wednesday, since there will be a staff party for us on Wednesday night, so that they will see us off before our last day of work on Thursday before going to Cagayan de Oro on Friday. If that happens, that is a unique outdoor adventure designed around me and with a nod to Alison who is a bird watcher, we might take on that mountain trek for a bird watching expedition with the telephoto I brought in the odd chance I might see the eagle if I got up to the summit of some peak around here like Mount Apo. As it is, we will be going to a seaside hotel resort at Cagayan de Oro where we might swim and do other relaxing things on the last day we have in the Philippines and on the last night we are here before we fly from there up to Manila for a five hour wait before beginning the long “double day” (crossing the date line on two Saturdays the 15 the February). So, as much as I am trying to get away to run, I will try to also do the outing to the mountains for natural history as much as I had to learn all about banana plantations in a tropical rainstorm on our single outdoor outing so far.
A couple of our nursing staff are going down for the count, not so much because this is a pestilential place, as that we have burned the candle rather rigorously on more ends than we have ends and have wound up exhausting us serially. It will be good to have a last day before leaving to relax, and not be looking at adding other cases as fast as they appear at the door.
On the subject of my dinner meeting last night with
Ruthie the administrator, who arrived when I was in the throes of the Internet
Cafe saga, she said that I might stop by her office, and she would make
available the password of her computer with an access to the Internet, so that
I might be able to send this Feb-B-series with less than the 48 hours of
non-stop frustration I had in getting the first and only messages I have been
able to transmit from Malaybalay into the Cyber waves, whether or not yet
received by you. So, I will try
tomorrow to send you a message to see if the latter tries are better than the
former, each of which suffered ingenious reasons for which it just could not be
counted on to work—but only after ALL the effort had already been expended in
vain. I will see if this can go, and
will try to connect tomorrow.
A’
LA’ EPHRAIM MCDOWELL—
DE JA VU ALL OVER AGAIN
The first patient of the afternoon was quite an imposing figure, and she is now a mere shadow of her former self. In fact, she is less than half of what she was. She was nearly identical to the last patient in TECH. She had a huge abdomen, as tense as it could be and she could not breathe easily since her diaphragms were pushed up so high. She could not lie down on her back without having this huge belly press down on her vena cava and interrupt blood flow returning to her heart. She was in trouble, since she had had this huge tumor for two years, and was scheduled to have this removed last year, but backed out since she was frightened. Now, it is worse, and somehow, I asked “She is now less frightened?”
She had found somewhere an ultrasound, and they said it was a multiloculated cyst, but also found a gallstone. So, at age fifty, she comes here to have her huge cyst removed, and her uterus and ovaries too, and, while we are at it, her gall bladder as well.
As I had with the Tboli patient from Lake Cebu, I put a big tube in her ovarian cyst and began draining fluid off her distended belly. Just a little of this fluid—30.5 liters to be exact—carried off in three plastic buckets She could breathe much better by the time we put in a spinal anesthetic. With a lower abdominal incision, I helped Ragon do the first hysterectomy of his life after we held up the deflated cyst—just as we had in the last patient at TECH, and posed for the cameras as we took this spare-tire-sized ovarian tumor out with a single clamp and stitch. The hysterectomy took a little longer, since the novice was doing it with a non-gynecologic surgeon, but the cholecystectomy was a breeze, since the patient had this very flaccid scaphoid abdomen after the majority of her body mass was removed from inside this distended belly. I said we could count her as three anesthetics (local for the drainage, spinal for the hysterectomy, and general for the cholecystectomy) and four cases for the drainage, then excision of the ovarian cyst, the TAJ &BSO, and the cholecystectomy.
We did a hemorrhoidectomy. We also had arranged for my fourteen year old sweet young girl with the awful facial deformity due to a cleft lip and gnoma which destroyed her midface, Josephine Tano, who had come up from TECH by road thanks to the generosity of the last group last year that collected money in the Manitoba churches and got together enough money to bring Josephine and several of our complicated reconstructions up to Bethel as we funded the arrival of a plastic surgeon from the Sebu City medical faculty to come here by air this morning. Josephine has now had her first stage done, a lip repair, and will need several stages more to get the midface grafted with flaps swung down to reconstruct her. She is such a good candidate, that I had written to Operation Smile and a number of sources to get her done, and did not want to try any part of it myself, since she would need several stages and I did not want her dropped in between by one team shuffling over to another. We selected three others as well to come up who would need staged reconstruction s over the following year, and the funds will beer used to support this ongoing effort.
A couple more hysterectomies, hydroceles and cleft lips were still part of today with many more of the same booked for tomorrow. This should give Ragon Espina and others a good training run, as well as fill up a book of photos on the amazing pathologic findings of Bethel Hospital patients to compare and contrast (and in the case of Ephraim McDowell – sized Ovarian Tumors—identical) to those of the more primitive facilities of TECH in Tboli land—and the same team gets them all done in each venue!