Language school was great but, in the final analysis, I am a surgeon. It’s good to be back in the OR again. Our first day back in Soddo was occasioned by my transferring 1000 lbs of concrete tiles from the truck to the back of the house for a little building project. This will become relevant later. 

The return to clinical duties has had a pediatric theme. We got back on a Saturday and I was called with a post-operative complication on Sunday. A young boy had received an operation four days prior for a bowel perforation. We’re not completely sure of the cause, though it could have been typhoid. He was now pouring intestinal content from his wound. We took him back to the OR and fixed the bowel (so we thought). 

On Monday, I had a three day old child arrive with a distended abdomen and no anus. He had a condition called an anorectal malformation. The more common name is imperforate anus. We did a procedure descriptively called an invertogram, where the baby is held upside down with a coin placed where his anus should be and then an x-ray is taken. It showed that the air in his blind-end rectum was close to the proper anus site. Since it looked close to the skin, we decided to try and create an anus at this time. Having done this once now, I felt completely confident (please catch the sarcasm). Anyway, by God’s grace, it went well and we struck “brown” easily. After clearing out all the meconium (baby poo), we created the anus in the midst of the muscle sphincter where his anus should be. By God’s grace, he did well and went home. Here are some fancy book pictures for any confused folks. 

 

 

By Tuesday, I was a bit sore. My back hurt but I figured hauling all the luggage and tiles adequately explained that. However, the pain in my groin that radiated into my, um, groin, didn’t seem to fit. Suddenly the training took over and I had a finger in place and was coughing and “bearing down” dutifully. Yep, I had a hernia. So, I got that fixed by a friend in Addis Ababa last Thursday. It was different being on the other side of the knife, but I really had a great experience. God truly provided in this and I’m so thankful for how it turned out. I’m doing good and am feeling better each day. 

The little boy I operated on for the post-operative bowel leak eventually leaked again. This is one of the most painful things to endure as a surgeon. You make judgment calls in the operating room every day, but sometimes you jack it up. This time I took him back to the operating room to do what I should have done the first time. The abdomen was a complete mess at this point and I really struggled to bring his intestine up to the skin as ostomies. It was difficult, but we just made it. He is doing better now, but I’m very worried about him. He is horribly malnourished and his wounds and ostomy care are a challenge. Please pray for him. 

  

 

We had another of our pediatric foreign-body-in-the-airway experiences. This was a three month old boy who presented with the usual story and clinical picture. Thankfully, he was maintaining his oxygen well though he was quite noisy with the breathing. We took him back to the operating room and Dr. Asle, our anesthesiologist, put a scope down and saw a big bean in his trachea. I scrubbed in and started opening his neck to open his airway. This one got a little hairy at this point. I was still trying to locate the airway for certain (they are quite tiny and slippery at this age) when Asle urgently told me the boy wasn’t moving air anymore. The airway had just shut off completely. So, I dove in and opened up the area I felt represented the trachea. Thankfully, I was right and an audible suck of air immediately opened up as the boy started breathing again. The bean had flipped up below his vocal cords and completely closed his airway. He was now breathing through the hole in his trachea. The upside is that the bean was close to the opening and we were able to fish it out easily. It looked like the usual culprit, half of a fresh coffee bean. He did well. 

 

 

 

Yesterday, I had the distinct displeasure of operating on someone and encountering something about which I was completely clueless. A 65-year old man came in with a partial bowel obstruction and he just wasn’t turning the corner with conservative care. When we opened him up, the last half of his small bowel was clearly abnormal but I have no idea what is going on. There were nodules in the wall of the bowel that probably represented enlarged lymphatic tissue. The outside walls of the bowel (on the side of the blood supply) were covered in this weird, foamy growth but the rest of the bowel looked fine. I took biopsies and we started antibiotics and tuberculosis medications but we’re leaning heavily on prayer. I took pictures (of which, I’ll spare you) and showed them to Dr. Kelemu, who has practiced surgery in Ethiopia for around 20 years. He also had no idea. 

Today, when I entered OR number one, I noticed this behind the door. It’s never reassuring. 

 

This morning, we operated on a nine month old girl with an enormous mass growing out of her right buttock. I suspect it is a malignant tumor called a sarcoma, possible growing from muscle; but I really don’t know. There was quite a hole after it was out, and the tumor had extended into the pelvis, but we were able to put it back together. Hopefully, she’ll do well. It will take about a month to get the pathology report back. 

 

It never ceases to amaze me what God leads us into here. It keeps me humble and ever in prayer to the Great Physician. 

Paul

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