05-AUG-B-7

 

OUR OPERATING DAY B EGINS WITH ROUNDS THROUGH

THE WARDS, AND THE COMMUNITY,

RECEIVING THANKS AND BLESSINGS OF GOD AND ALLAH,

BEFORE A SERIES OF THYROID OPERATIONS: 

THE FULL SPECTRUM OF THYROID MASS LESIONS

 

August 11, 2005

 

 Once again, it is a full spectrum day, this time revolving around the thyroid and the different mass lesions of the gland, with hyperfunction added for tomorrow’s list.  In the middle of the day, Huda Ayas, recently arrived here form the GWU International Medicine Programs, came by to visit us and may join us and Dr. Meghiru Mehari for dinner tonight.

 

Our day began at a request form Steve Katz, the professional photographer from Norfolk, who is commissioned to take pictures that PFP can use in its reporting and fund raising.  He already has a lot of video and digital still photography, and had a chance to follow us around through the “full spectrum general surgical day we enjoyed yesterday.  But, he said he had more than enough OR pictures which can not necessarily be shown to public audiences everywhere anyway, but that he needed more photos showing the community and patient interrelationship with the team.

 

We got all that in overwhelming abundance as I arrived to see the post-operative patients.  First off the fellow who already recognizes the differences that have happened overnight since his prostate resection and recurrent hernia repair yesterday and is flexing his muscles in his arms overhead, and clapping me on the back and showing that once again he has a new lease on life.  He is all smiles despite all the tubes and bottles around him from the flow through irrigation.  As I had said before, the operation is one part of all this but the nursing care to be sure that the catheters do not become plugged by blood clots. The nursing care was meticulous and thorough; in fact, our Recovery Room nurse Tzion from Howard University and Beltsville Maryland is probably running a recovery room better than any I have seen back home!  Our well controlled little hospital here is turning out more volume than a multi-specialty surgical center elsewhere, largely because we are doing all the specialties ourselves and using the same hand-picked team for our assistants.  I would rather stay here than rotate around, even though I was advised for big cases , like the repair of the eventration of the diaphragm eight months after a big accident should be done over at Halibet Hospital—a place where they could manage a ventilator patient and a thoracic surgical procedure. Well, I am every bit as much a thoracic surgeon as I am a gynecologist or a urologist, and am a stranger to none of the above, so I would rather do it here with the trusted assistants and competent hand-picked team who are here with this reawakened surgical program in this small but well-functioning program than start up a new in facilities that may be larger or more expansive but with which I am unfamiliar.

The prize winner in the praise and rejoicing department was the wife of the man with the bowel resection for intestinal obstruction.  She was eager to see us, and clasped my hands kissing them and raising them to her head and then gesturing to heaven.  During the rounds around our post-op patients not only did we see that they were all doing well, but I also had been blessed three times before God, and twice before Allah.  She was in raptures since she knew as well as anyone that her husband was in extremis when he came to us, and that now he was full of smiles and was walking around with not only active bowel sounds but also “hunger!” as his chief complaint.

 

We then entered the larger patient census of the pediatric ward where we saw a couple dozen cute kids in little snowsuits with sun bonnets, each of which also had a nasogastric feeding tube taped in place to force them with fluids for diarrhea disease as well as nutritional support. They were cute kids who completely ignored their tubes and even were trying to eat finger foods around them.  I explained the principle “Under Five” Child Survival programs called GOBI for the five highest cause of death on planet earth.   GOBI stands for Growth Charting and “road to health” record keeping, then Oral Rehydration Programs, Breast Feeding, and Expanded Program in Immunization.  These programs are for the help in reducing the terrible toll in wastage of the kids’ lives under five years of age, from DAMMM: Diarrhea, Acute Respiratory Diseases, Malaria, Measles and Malnutrition.  So, we had a very instructive ward round as well as a highly photogenic one.

 

We also met a number of our pre-op patients including a few we canceled.  One was a woman who seems to have a lot of metastatic lung nodules apparent in her chest X-Ray, and we are looking into hat after the X-Ray was repeated confirming the same.  I said she was at greater risk to life from the metastatic disease than any worries about her thyroid.  She was on anti-Tb Rx at one point but she quit, and she has a negative AFB test now.  There were two smaller goiters I though might be deferred, with the interval given to treating them with cold Lugol’s Iodine.  Then we came to my young woman with the inflammatory breast cancer.  I explained to her that we might need to take a skin graft from her thigh to put it on her chest wall after the mastectomy and we would be giving her the medicine that we would try to get her from America that she would take after this operation removed the painful and unclean breast cancer.  She then said “God Bless you” the same greeting and salutation I got form the hot thyroid we will do tomorrow and the young man with the eventration. These are unusually grateful people.

 

Huda Ayas had gone home rather than risk the appearance in an OR setting in which she would have felt very uncomfortable, and so had the photographer Steve Katz.   We waited for our driver and the ambulance ride back to the Central Hotel, but he was out picking up oxygen for the Halibet Hospital crews.  We waited and during that interval another cholecystectomy happened by to be done so that was our final case of the day.   We will see what we will be able to do tonight, but I am running out of Nafka and must find a bank soon.  We will be hosting several folk whom I will cover and I have only fifty Nafka after my expenses of mailing the first (and only batch so far) of postcards to have been posted out of Asmara.  I hope they arrive, as none of mine did when I had mailed them out of Haiti last year, even after the money had been paid in the Port au Prince post office.

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