Surgery day in Impfondo. Boni is back and we had some cases scheduled for the day. Couple hernias, cellulitis/dead tissue/pus drainage from a leg, pus drainage from other places (the usual pus stuff, you're probably just used to it by now it doesn't phase you.....right?), and fixing up an infected post-operative wound that happened I think when she was violently vomiting. Anyway, had a few cases for the day and split them up with Sephora. The first hernia repair, one of the Congolese guys assisted as I arrived and they were already starting. After Boni asked if I would scrub into the next case, which I did, and that went quite well. I closed up and walked Sephora through how to do some closing sutures, running sub-cutaneous and others. She assisted Wegner with cleaning out the lady's abdomen that actually didn't look as bad as we were expecting. He threw in some retention sutures (basically a big suture through all the layers to try to close it) and we're hoping it holds and she doesn't get infected again. I helped Boni then with our cellulitis kid. I can't quite remember if I mentioned him from yesterday evening or not. He's a younger guy, 15 maybe? Hard to tell with these kids. Anyway, two weeks ago he cut his leg pretty good and never really cleaned it out, and it got terribly infected. Infection, dead tissue, and yup more pus. We had to cut away all the dead tissue and drain out the copious amounts of milky green pus. It's kind of like the case on Day 1 in Impfondo, the one where we were supposed to graft the skin but couldn't the other day. Anyway, this kid will definitely need a skin graft now. We resected a LOT of tissue and cut down pretty good to try and get rid of all the dead stuff and find the abscess pockets. Maybe resected a bit more than we need to, but the guy with the knife is the boss (which wasn't me in this case). We'll see how he progresses and they'll do a skin graft after I'm gone. The surgery overall went really well, and now it's just hoping the kid isn't in too much pain. His spinal didn't really take too well, so he was moaning and groaning the entire time.
I went back and grabbed lunch, which was some grilled chicken and avocado that Sarah picked up for me. Again, delicious. Love the food here. I went back and met up with Boni to drain another abscess. Not sure exactly what happened, but the woman's left breast was basically one giant abscess. I think they gave her some diazepam, but when we were gonna do some lidocaine, the nurses were like, "No, just cut." So we cut. Made an incision and the nastiest looking green pus came out (by nastiest I mean most satisfying). Boni had to squeeze the tissue like an orange and for quite a while more and more pus drained. We broke up the loculations inside and drained, irrigated and drained, squeezed some more and drained. The poor woman was screaming the whole time, and I think the nurses were making fun of her, but they seem to do that whenever anyone screams here. They're such tough people that if anyone makes a peep they're like "stop whining!"
I finished up with the case and went off to find the group. I went to the Salles de Urgences to find Wegner, Kiong, Amanda and Sephora trying to resuscitate a kid who had just come in and stopped breathing. Not sure entirely what was wrong, but they were trying to give him as much oxygen to keep him going, so I helped. Wegner asked me to find a pediatric LMA so we could try to oxygenate better, so I hopped on the bike and flew off to look for one. When I got back, we put in the LMA, and started bagging. Then I ran off to find the CPAP machine from the newborn suite. Grabbed that, carried it back. Then, as I arrived, he lost his pulse. We started CPR. We gave adrenaline and did a few rounds of CPR, trying to think of anything that could be causing it. I ran off to grab the echo to get a look at his heart. I got back, ultrasounded the heart, and we started to get a heart beat and a pulse. Yes, some hope. Continued talking about what else we could do.....pulse gone again, restarted CPR. This continued for a while. We started an adrenaline drip and back and forth did CPR until we got a pulse, until we lost it and started CPR again. This continued for about 2 hours. Clothes soaked with sweat all the way through, hands cramping from bagging and CPR, racking our brains thinking of anything we could actually do for this guy here in the Congo, and realizing there was nothing else, we had to call it. Another dead child. I'm starting to see it wearing on people here. Maybe I just missed it before and it's been wearing on them. But since I've been here I can't quite remember how many kids I've seen die, but it's been a lot. I've done CPR on 3-4 of them myself and lost them. I can't imagine what Dr. Wegner is thinking or what he has to deal with here. Again, it's not that we lose them, because we lose patients and even in the states people die in our ERs. But, I still feel like we've done the best we can to save a patient's life in America. Here, not so much. Here we can't check a BMP to see what the sodium and potassium are. We don't have cardiac monitoring. We don't have positive pressure ventilation. So when a kid dies, potentially from lactic acidosis causing hyperkalemia, and we have no way to know for sure......it's pretty terrible. We tried our hardest though and gave the kid a two hour window.
Afterwards I ran home to shower (a lot of running today) and Amanda and I rode back to meet up with Rob and Kyla for dinner at their house. Rob is doing a soccer ministry here in the area, and it's pretty cool. They're both awesome people, and their two kids are great, and they all have the coolest accents. They had some pretty great food for us and it's great to hear all the perspectives on global health and such, and I feel blessed to get to know these people all so well, even in my short time. They really are amazing, and it's a privilege to work with them and learn from their experiences.
Tomorrow I meet up with Sarah Spear to do some home visits. I have to be at her house at 7am, so I have get up early to ride my bike there, so I'm going to turn in. Can't wait to update you more tomorrow with everything. Thanks!
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