OR Day Three

The last two days have been long but productive ones! Yesterday we took out a 13 and 1/2 pound uterus (the second biggest that Tom and I can remember taking out together) and went to the hospital thinking that was the only case we had scheduled... those of you who know how things go down here are probably snickering at that since you know it didn't stay that way!

So Tom had two patients waiting for him in the ER when he got to work in the morning, and promptly diagnosed one as very sick from her gallstones and the other with a likely colon cancer. We operated on the lady's gallbladder, then did a sigmoidoscopy to confirm the tumor diagnosis before operating on him today.

This morning Tom started with the colon tumor with Maryann while I did what I had hoped would be a "quick little LEEP" procedure in the clinic downstairs. I was so glad that Keith Nelson had just done his Grand Rounds on the use of electrosurgery, since I actually had some idea how to use the machine that we had available. Having NO idea what to set the power at, I hopped down to the butcher shop to buy some meat to experiment with before getting started. Then we spent an hour or so troubleshooting why only one setting would work, and the last experiment I did was with both the meat and the grounding pad on my calf while I cut the meat with the Bovie. (I called Keith at his clinic before trying this just to make sure I wasn't missing anything in my understanding of electrosurgery!)

By then there was a patient in the Emergency Room that they asked me to see-- a 36 year old with 5 living children (although she has given birth to 8...) with vaginal bleeding and saying she is 3 months pregnant. I spent the next 5 minutes or so diagnosing her with about an 18-week sized Molar pregnancy, and the next hour or so trying to explain this to her and her family and talk her in to a hysterectomy. (For the GYN types out there, I'm not really excited about trying a D and C on that with nothing but wall suction, pitocin, and methergine-- Remember I have no blood bank here...)

Unfortunately, so far Marta has refused surgery-- she insists that she feels her baby moving inside of her, and wants to wait out her nine months and see what happens. I am heartbroken over this, but she is supposed to come back in the morning to get the results of some labs so I am hoping for maybe a change of heart overnight. I am afraid she will bleed to death from this if we don't take care of it soon.

The rest of our cases went well today, except for the colon cancer tumor turned out to be inoperable (It was too stuck down to some very important veins for even Tom to be able to safely remove). Tomorrow we have several more lined up, and I will be praying tonight over Marta's case as we might do her hysterectomy. Please join me in that!

(I tried to post a picture of the electrosurgery machine but I can't get my phone to send it to me... sorry!)