Amputation
Hanouk got his leg amputated yesterday! Despite his 5-yr survival chance of 55%, at least now he has a fighting chance.
WARNING: If you don't want to hear all the details of the surgery, DO NOT read on. For those of you with strong stomachs, the world of Ethiopian surgery awaits....
Stu and I arrived @ Black Lion hospital at 7:30 yesterday, but of course couldn't find anyone to talk to until 8:30. At that time, Dr. Biruk's assistant brought us up to Floor 4 - The OR. We waited outside for an hour until we finally asked a passing doctor and found that Dr. Biruk was already in his first surgery of the day, a "hip angle plating" (basically the patient snapped his femur right below the pelvis and they were putting in a few angled plates and screws to help it grow back together - as Resident Ray calls Orthopaedic Surgery, "glorified construction"). Instead of bothering him right then, Stu and I went to hear a presentation on the "Management of a 30 yo female patient presenting with anterior neck mass." The case ended up being Medullary Thyroid Carcinoma and the resident who presented spoke good english and had an interesting powerpoint.
After the talk, we walked back into the operating theaters to find Dr. Biruk (note: we can only do this because we are white and pretend like we know what we're doing). Once he finished the hip surgery, Dr. Biruk told us to throw on some scrubs and join him in the OR. Along the way we saw Hanouk who was rather calm, cool, and collected considering the surgery he was about to undergo. We wished him luck, figuring the next time we saw him he would be anesthitized in a deep sleep...wrong. So Stu and I made our way into the OR just as they were finishing the hip surgery; we saw the incission get dressed, the breathing tube removed, and the patient moved off the operating table with all the accompanying groans. The operating table, the floor around the table, and a few other areas of the linoleum floor were covered in blood. Forceps, scalpels, gauze, and sponges were mixed in as well. Although not scrubbed in, Stu and I were invited to stay seated while they "cleaned" the room before Hanouk's surgery. And by "clean" I mean that a lady walked in with a broom, a mop, and a bucket of plain water. She rinsed down the table, mopped up the pools of blood, and swept up the trash. That was the cleaning of the room.
As for the equipment in the room - The operating table looked c. 1965 - institutional green pads that are velcroed to a clear plastic table that rests on a metal stand with foot pump and crank to raise and lower; there are two operating lights similar to the ones in the US; there is an ECG machine (albeit the electrodes have no pads and are simply taped to the skin); the tools are autoclaved and all gowns/sponges are reused after they are cleaned somehow. Most notably absent piece of equipment - No automatic blood pressure monitor; patient wears a cuff with stethoscope secured underneath and a nurse checked his BP every few minutes. Also, the room had a lightboard for x-rays but it was broken, so the x-rays were taped to the window. The upside of having such simple equipment was that when the power went out for one minute during the amputation, nothing really stopped/changed.
So Hanouk was wheeled in and we watched as the anesthesiologist injected a subdural spinal block rather than giving him general anesthesia. For those of you who don't know, a spinal block is an injection of a numbing agent directly into the spine; in this case it was given to numb Hanouk's body below the waist for ~3 hrs. This is allegedly one of the most painful procedures one can have and Hanouk did not flinch...I did. When the doctor found out that I had donated a pint of blood for the surgery, he invited me to scrub in. Who knew that donating blood came with such privileges? And so I scrubbed in for the first time, anxious and excited to observe/participate in the operation.
The operation was carried out by an attending physician, a 3rd year resident, one nurse who was scrubbed in, and myself. There is nothing delicate about an amputation as it requires primarily brute force, a sharp knife, a saw, and some string for sewing it up at the end. My duties during the surgery included using a sponge to soak up excess blood, pulling on "the claw" to help keep the tissue back while the MD scraped the femur to remove any attached tissue, holding the shield in place while they sawed through the bone (more on this in a second), holding the bone while they tied up the arteries, and holding the leg in place while they closed up the stump. I had to sit down a few times (maybe my lack of dinner the night before and no breakfast the morning of were poor decisions) but I was never out for the count and every time I came back to the table, the physician grinned at me and said "You will never forget this"...oh how right he was.
Now to elaborate on my favorite parts of the surgery:
~The Spinal Block vs. Anesthesia - As outrageous as it may seem, I don't think anesthesia here is safe (at all!) and so a spinal block was a good, albeit freaking crazy, option. It makes me cringe to think that Hanouk was able to hear all of the work going on below the drape...
~The Saw - The saw they used to cut through the femur was a hand saw, identical in form to a hack saw. The first one they tried using was extremely blunt, failing to make any significant progress after five minutes of steady sawing. Again, the thought that Hanouk heard all of this makes me shiver. When this first saw was obviously inferior, the doctors started shouting at the nurses to go get another saw. They did and the new tool cut through the bone like a hot knife through butter. They said they are looking into buying an electric saw, and as Stu incredulously asked me later, "Why are they just thinking about this now?!"
~The Box for the Leg - When the leg had been fully removed, the nurses placed it in a cardboard box that the boxes of disposal gloves were shipped in. No biohazard bag, no sealed container, but a cardboard box seemingly pulled from the trash pile. Welcome to Africa.
Needless to say, the entire experience simply reinforced my strong aversion to ever having any kind of surgery in this country. This must be one of the worst facilities in the entire world that attempts surgery and it is crazy to think that this is the flagship hospital for the entire country (although the doctors did say that other hospitals had better supplies).
Hanouk did great during the surgery and said he had a good night when I talked to him this morning. He will recover for about a week and then we will begin chemotherapy. 'Twas a crazy morning and an intense first surgical experience.
WARNING: If you don't want to hear all the details of the surgery, DO NOT read on. For those of you with strong stomachs, the world of Ethiopian surgery awaits....
Stu and I arrived @ Black Lion hospital at 7:30 yesterday, but of course couldn't find anyone to talk to until 8:30. At that time, Dr. Biruk's assistant brought us up to Floor 4 - The OR. We waited outside for an hour until we finally asked a passing doctor and found that Dr. Biruk was already in his first surgery of the day, a "hip angle plating" (basically the patient snapped his femur right below the pelvis and they were putting in a few angled plates and screws to help it grow back together - as Resident Ray calls Orthopaedic Surgery, "glorified construction"). Instead of bothering him right then, Stu and I went to hear a presentation on the "Management of a 30 yo female patient presenting with anterior neck mass." The case ended up being Medullary Thyroid Carcinoma and the resident who presented spoke good english and had an interesting powerpoint.
After the talk, we walked back into the operating theaters to find Dr. Biruk (note: we can only do this because we are white and pretend like we know what we're doing). Once he finished the hip surgery, Dr. Biruk told us to throw on some scrubs and join him in the OR. Along the way we saw Hanouk who was rather calm, cool, and collected considering the surgery he was about to undergo. We wished him luck, figuring the next time we saw him he would be anesthitized in a deep sleep...wrong. So Stu and I made our way into the OR just as they were finishing the hip surgery; we saw the incission get dressed, the breathing tube removed, and the patient moved off the operating table with all the accompanying groans. The operating table, the floor around the table, and a few other areas of the linoleum floor were covered in blood. Forceps, scalpels, gauze, and sponges were mixed in as well. Although not scrubbed in, Stu and I were invited to stay seated while they "cleaned" the room before Hanouk's surgery. And by "clean" I mean that a lady walked in with a broom, a mop, and a bucket of plain water. She rinsed down the table, mopped up the pools of blood, and swept up the trash. That was the cleaning of the room.
As for the equipment in the room - The operating table looked c. 1965 - institutional green pads that are velcroed to a clear plastic table that rests on a metal stand with foot pump and crank to raise and lower; there are two operating lights similar to the ones in the US; there is an ECG machine (albeit the electrodes have no pads and are simply taped to the skin); the tools are autoclaved and all gowns/sponges are reused after they are cleaned somehow. Most notably absent piece of equipment - No automatic blood pressure monitor; patient wears a cuff with stethoscope secured underneath and a nurse checked his BP every few minutes. Also, the room had a lightboard for x-rays but it was broken, so the x-rays were taped to the window. The upside of having such simple equipment was that when the power went out for one minute during the amputation, nothing really stopped/changed.
So Hanouk was wheeled in and we watched as the anesthesiologist injected a subdural spinal block rather than giving him general anesthesia. For those of you who don't know, a spinal block is an injection of a numbing agent directly into the spine; in this case it was given to numb Hanouk's body below the waist for ~3 hrs. This is allegedly one of the most painful procedures one can have and Hanouk did not flinch...I did. When the doctor found out that I had donated a pint of blood for the surgery, he invited me to scrub in. Who knew that donating blood came with such privileges? And so I scrubbed in for the first time, anxious and excited to observe/participate in the operation.
The operation was carried out by an attending physician, a 3rd year resident, one nurse who was scrubbed in, and myself. There is nothing delicate about an amputation as it requires primarily brute force, a sharp knife, a saw, and some string for sewing it up at the end. My duties during the surgery included using a sponge to soak up excess blood, pulling on "the claw" to help keep the tissue back while the MD scraped the femur to remove any attached tissue, holding the shield in place while they sawed through the bone (more on this in a second), holding the bone while they tied up the arteries, and holding the leg in place while they closed up the stump. I had to sit down a few times (maybe my lack of dinner the night before and no breakfast the morning of were poor decisions) but I was never out for the count and every time I came back to the table, the physician grinned at me and said "You will never forget this"...oh how right he was.
Now to elaborate on my favorite parts of the surgery:
~The Spinal Block vs. Anesthesia - As outrageous as it may seem, I don't think anesthesia here is safe (at all!) and so a spinal block was a good, albeit freaking crazy, option. It makes me cringe to think that Hanouk was able to hear all of the work going on below the drape...
~The Saw - The saw they used to cut through the femur was a hand saw, identical in form to a hack saw. The first one they tried using was extremely blunt, failing to make any significant progress after five minutes of steady sawing. Again, the thought that Hanouk heard all of this makes me shiver. When this first saw was obviously inferior, the doctors started shouting at the nurses to go get another saw. They did and the new tool cut through the bone like a hot knife through butter. They said they are looking into buying an electric saw, and as Stu incredulously asked me later, "Why are they just thinking about this now?!"
~The Box for the Leg - When the leg had been fully removed, the nurses placed it in a cardboard box that the boxes of disposal gloves were shipped in. No biohazard bag, no sealed container, but a cardboard box seemingly pulled from the trash pile. Welcome to Africa.
Needless to say, the entire experience simply reinforced my strong aversion to ever having any kind of surgery in this country. This must be one of the worst facilities in the entire world that attempts surgery and it is crazy to think that this is the flagship hospital for the entire country (although the doctors did say that other hospitals had better supplies).
Hanouk did great during the surgery and said he had a good night when I talked to him this morning. He will recover for about a week and then we will begin chemotherapy. 'Twas a crazy morning and an intense first surgical experience.
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