Delays, delays....my neck!!

Rather eventful day today.  I think it's been awhile since I've shared some of the morning ER happenings with you guys. Things have been relatively quiet during my trauma bay rounds over the past few days (mind you, my "quiet" is equivalent to "busy" back in the states..).  This morning I saw a guy that had come in a few hours earlier who was riding a pam-pam and was hit by a car.  He apparently was dragged under the bike for a distance and came in with this gapping mangled foot.  His wound was all contaminated and he had left about 25% of his fibula on Tubman Boulevard!!  His xray was pretty impressive-the entire end of his fibula was just missing!  His ankle joint was almost completely exposed on one side.  We did a washout and debridement in the ER which took a bit of time so I ended up starting a little late this morning in the operating room.

I was a bit disgruntled this morning on rounds.  I think my amputation patient has an infection in both of her legs.  She has been draining from her incisions, and this morning I had to remove a few sutures to decompress her wound.  It was pretty uncomfortable for her and she was crying.  Some of the other nurses came into the room to console her while I was tending to her...I keep telling myself that she would've otherwise been dead...

Really could've used a microscope! L.I.B. baby!

When I got upstairs to the OR I was delayed even longer because my first patient was having second thoughts about surgery...again.  He is a young guy with a really bad distal femur fracture after an RTA.  When he initially came in I recommended surgery to him, but he refused and wanted 'herbie' to take care of him.  He ended up back in the clinic continuing to complain of pain-as expected.  At that time we revisited surgery again, but he was reluctant and apprehensive, worrying that the "iron will cause cancer" and that he would eventually end up with an amputation.  After long debating and answering all of his questions, he still refused surgical intervention.  He wanted to speak to one of his patient care advocates.  The next day I get this phone call from one of the patient reps from his religious group asking all of these questions about surgery-the same stuff I had just explained to the patient.  After another long conversation with the representative, the patient was finally amenable to undergo surgery....almost 4 weeks later!  He was scheduled for the first case this morning, but when the anesthesiologist met with him, she was concerned that he didn't have any blood on hold for surgery.  Because of his beliefs, he refuses to accept any blood products even in the event of trying to save his life.  The anesthesiologist had a big issue with that and ended up telling the patient and his rep that she was unwilling to do the case!  She was concerned because of having seen patients bleed out in surgery and wasn't comfortable taking him to the OR without having blood available.  Long story short, the rep ended up going to the general administrator of the hospital to have her sign off on some form that relinquishes the hospital or any person involved in his care from liability should something happen to him....a lot of hoopla.  I was kind of caught in the middle of everything, but just rolled with the flow.  It was a bit frustating though.  I ended up moving the case to Monday.

I did a cool case today when I finally got into the OR.  This lady had an unfortunate incident where she was attacked by a robber in her home with a machete!  He cut her shoulder, neck, and forearm lacerating several of her tendons and one nerve.  I was able to repair her ruptured tendons and even her nerve.  I was pretty pleased that everything came together-I just hope she heals and has decent function.  It was a very tedious surgery and took awhile though.  Usually back in the states we use a microscope when repairing nerves and vessels, but remember....this is L.I.B. baby!!  My neck was killing me at the end of the case!!  I was stooping over so much trying to repair that tiny little thing with the smallest suture!!  I'm gonna need to find a good Liberian masseuse this weekend. LOL!  She also had a fracture that I placed into an external fixator.  Great case.

Me and Mrs. Howard at JFK-one of the volunteer advocates.

After I left the OR I went downstairs to do a bedside procedure on the guy with the fight bite (remember him?).  He has been doing great, but his finger just is not turning the corner and is infected.  I counseled him earlier that he may end up losing it, which he understood.  I ended up amputating his index finger this afternoon.  I've never had someone thank me so much for removing their digit...

Once he was finished I made my way down to the ER to check on things and ran into the 3 orthopaedic cast techs about to reduce a really bad ankle fracture/dislocation on this old lady who was hit by another pam-pam (those guys are no joke!).  They were all ready to yank on her leg when I asked what they had given her for pain-I knew she was going to be in a lot of pain because her ankle xray was one of the worst I've seen.  I didn't think she was appropriately anesthetized, so we ended up filling her ankle joint up with lidocaine to make a her bit more comfortable.  Seemed to work okay because after the injection they were cranking on her!     

All around eventful day at work.  I have been keeping a running log and power point presentation of everything that I have done while here and I reviewed it this evening-man I've seen some stuff over here!!  I have gotten so used to it that I almost forgot how impressive some if has been; this is one wild ride.

The gees!!

I met with the tailor today to make my scrub caps, and he showed me the 3 patterns he had in mind.  I brought him a disposable surgical cap from the hospital so that he has an idea of how it's supposed to look.  The patterns look HOT!  I can't wait to see them!  He says he can do it no problem.  Will let you know-I think the first barber I went to said he could do it "no problem" too...LOL!

Monie invited me out to Firestone again tomorrow and then on Sunday I'm going to watch the Superbowl with friends.  Looking forward to sharing with you all.  Have a good weekend everyone!

"Fear can keep us up all night long, but faith makes one fine pillow..."

-Unknown

Great wall sticker in the MRC (Monrovia Rehabilitation Center).