I sit in the Ha Noi airport as I begin this entry. It is otherwise completely unremarkable, just another mélange of overpriced duty free shops littering an international airway terminal. As this week has rounded out, I’m quite excited to return to Vientiane, where things don’t cost so much, and the taxi into the hills doesn’t charge complete fare for both directions of travel. It’s all part of a learning experience I suppose, and now knowing what I do, I will not take the “flying coffin” so-named by the nationals, or a taxi, but a coach when I rumble up north through the mountains. I do fully intend to return there, an absolutely breathtaking and serene part of the world, at least when your bus isn’t playing chicken with the one opposite, and motorbikes going either direction are scattered about the road like traffic cones, completely at the mercy of the bus-drivers, who happen to be merciless. Oh well. I’m alive.
If there’s anything else I’ve learned over my first week here, in northern Vietnam, it’s that surgery is like sex to doctors here. Maybe it is at home too. But here, after a trip to the OR, they retire to their report-writing while working their way through packs of nationally-grown cancer sticks. They offer them to everyone, “You want to try Vietnamese cigarette?” and as both Mark and Rob shook their heads and snickered, the doctors, smoke pouring from all three facial orifices, seem confused.
My four days in Son La concluded after seeing some 12 surgeries in two days of operations. Aside from the number of corrective foot and ankle operations, I was privileged to be invited into the OR across from ours, where two general surgeons were talking to a patient receiving a spinal block somewhere in his thoracic vertebrae. As the second exited to scrub, he explained to me that they were about to remove a bladder stone and a tumor the man had growing from his prostate. As they scrubbed, the patient was sterilized with copious iodine, this was typical, in my experience at the Son La hospital. I secretly prayed to myself that none of these patients had iodine allergies. I don’t think Betadine even exists up there (a town of only 100,000 or so), and I seriously doubt that iodine allergy is part of the patient history. Oh well, I didn’t see any harm done (I assume this part of the philosophy of western medicine wasn’t lost as it moved east).
I leaned over the table, camera in my hands or behind my back, snapping shots or squinting to see through the maze of two pairs of hands and retractors in this man’s abdomen. Everything seemed to glide along the effacing muscular walls along the incision as not to displace something inadvertently. (Though towards the end of the procedure, the spleen avulsed from under the retractor and both doctors worked to keep it in place as they put their first set of sutures into the abdominal muscles.) The most interesting thing to see was the separation between the connective skeletal and sub-skeletal layers and the organs which lay underneath. The bladder was opened up with ease, and the stone removed. If you put the tip of your forefinger and your thumb together, you’ve got about the size of the stone, ovular and perfectly round. A coal black surface covered by what looked like microvasculature, dark red in color and hardly apparent against its black background. If you found this thing on the beach, you’d think, eh, pretty cool. But seeing this thing come out of a man’s bladder about 400ccs in volume, you wonder how it was living with that inside of him.
The prostate came out next. They worked their hand into the pelvic cavity, slowly cauterizing anything that looked like it might bleed and wasn’t essential. After some cautery and scalpelry, out it came, even bigger than the stone. The doc said it was the tumor, but I’m convinced at least some portion of the prostate came out with this thing. You know when you see all those ads on TV for enlarged prostate? Well this thing was much larger than you would ever think an enlarged prostate could be. Both specimens were set on the sterile table at the foot of the bed, the tumor (prostate) headed to the lab afterward. It wasn’t overwhelming, but this procedure was clearly bloodier and much gorier than any of the orthopedic procedures I’ve seen. I contribute this partly to the use of a tourniquet, but mostly to the physical approach and the peri-operative injuries the surgery necessitated.
The second surgery I watched with the Vietnamese doctors was a kidney stone removal. Apparently, this man had two kidney stones, one in each kidney, the one on the right had advanced into the ureter, and it needed to be removed. The other, I guess, was not so important. They opened from the front, through the right side of the abdomen, and soon were looking at the right ureter, about 4mm in diameter. This was easily opened, the stone--the shape and size of a pill removed--and then the operation was closed up, with a drainage catheter emanating from his side, just the same as in the previous procedure. This part was interesting to see, they don’t have premade drainage tubes, so they take the tube they have, bend it every inch of so and snip off the corner to make a hole. With a pair of clamps, they pushed through (from the interior) of the abdomen until they broke into the subcutaneous layer, the other surgeon opened with a scalpel where the clamps were, and the tube was passed through, then sutured and tied to the skin.
The doctors packed up around 1:30, after surgery concluded on Thursday, did some rounds Friday morning, and then we hopped on the bus and headed back to Hanoi, to celebrate with a famous Vietnamese dish, hot and sour fish. Cha Ca. This stuff is unbelievably good. That concluded my first stint with orthopedists in Vietnam. Sunday I took my flight home to Vientiane to find Sophia worked to the bone by her CMC (Cluster Munitions Coalition) boss, and whining about it of course.
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