AND A STAFF LECTURE ON TROPICAL SURGERY

Feb. 12, 2002

Another full day—with a lecture added to the lengthy operating schedule!

We started with a male with a goiter, and were surprised to see the right lobe had a firm capsule around it, which burst later in the case and proved to be a thyroid abscess. The next case was a hysterectomy for carcinoma of the cervix, with invasion of the vaginal cuff and involvement of the nodes along the pelvic sidewall. We had a break while the cleft lips and patients from Tboli land were looked over on our postoperative rounds. There followed a five-course dinner for lunch—the calories keep coming even in the absence of long distance running!

I went back to the OR to begin what was booked as a man with a seminoma or some such testis tumor. When I got there, it was not a man, but a woman, and it was not Allen who was interested in the iliac fossa approach from my transplant experience, but Regan Espina, who was keen on operating with me to do the hysterectomy. It was a good start, but a somewhat exasperating experience later since he would be timid in the face of an increasing amount of bleeding in a deep hole in the pelvis, and stare at it, looking at his instruments rather than taking action—and pronto—as was indicated by the continuing welling up of the blood from the deep hole in which nothing could be seen. When I had taken over after the seventh attempt at putting a clamp or stitch in the side of the uterus broad ligament and failing to control it, I put a suture into the side wall and tried to do a rapid control and move to the other side with a lap pad stuffed back in the spot to be revisited later. That seemed to work, but we went down to the other side as he made timid bites along the uterus, resulting in his turn in before the cervix was reached. That meant that we would have done a supra-cervical hysterectomy, if we had not extended down into the hole produced at our exploration for bleeding, so we made a “trimming up” incision around the vaginal cuff, which stirred up more bleeding. I got more actively involved at this point for several reasons. The woman had lost about two units of blood by this point and we had none to transfuse. Second was that I was supposed to d o the seminoma to follow, and also give a lecture to the staff at 4:00 PM and it was already 4:55 PM

I went to the lobby where the lecture was to have been held, and only a few people were there, but they came in a gush and materialized with helpful items, including a slide projector, a 110 V converter, a screen, and a large enthusiastic group of the BBH staff. Since I did not know how much of my language would be understandable, I made my talk very interactive, with a lot of participation, taking a recollection of the favorite songs they have here which they call “action songs”—the kind of forced interaction in participation that would make me cringe under most other circumstances—songs with “actions” require you to raise your hands or make a sign of some kind to go along with the music. This Sunday School kind of program would be the reverse of almost any other audience I would like to involve, since I would rather depend on the substance rather than the performance of the lecture to be riveting. In this case, it must have been a bit of both, since the subject got not only understood but also discussed with many requests for repeat performances. Last year I had given a goiter presentation in Mindanao. But, I said to them that I would be talking to them about Africa, and then talking in Africa about the Philippines.

We still had a case to do, after the lecture, and despite the buzz of everyone still carrying on as I left, I went back to the OR and got my way into the iliac fossa for the very first time since I was doing that very regularly as a transplant surgeon at
GW. I made the incision in the fellow with the testicular mass, and clamped the spermatic cord. We amputated the cord high and then had Janet section the specimen off the table. At a glance I could see it looked like a seminoma, and not the orchitis he had been under treatment for 6 weeks to clear. So, the diagnosis was secure, and the orchiectomy was performed, and the groin was further opened in order to do the deep iliac and superficial inguinal node dissection. This was handled swiftly, and I have staggered back to the Guest House to get an early start on the evening, because I hope to get up early tomorrow and try to get out and run after all.

We have a series of cases tomorrow, including a splenectomy for hypersplenism, several goiters and a couple of clefts and a few more hysterectomies. Tomorrow may be the chance to get out and look around while there is still daylight to see if we can see the surroundings. Tomorrow evening will be their program in our honor, so we will be there and try to tape a bit of it and shoot a few more pictures which will give you a complete photojournalism display of the experience when I get all these data organized

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