When I pulled in yesterday, I had just missed the end of the first day of surgery. Monday was all clinic and prioritization. Here care may be less urgency-oriented and more “what is fixable” meaning any number of things. Not everything is possible in the OR here. Instrumentation is whatever the docs brought from home and that prevents a lot from being done. This may come as a big shock to all three people who read my blog, but there are no reps here with a big shiny room full of blinged-out metal knees, hips, etc. There aren’t plates and screws to fix anything internally. (Though I did watch a Vietnamese doc ream out the proximal portion of a femur, insert a half-meter rod back up through the head from the fracture site, and then hammer it back down through the distal portion to set it.) There are pins and things, but no power-tools. Also, prognosis is dependent on follow-up visits and complication likelihood (among hundreds of other things), which is prohibitory to many more procedures.
Back up to the surgery ward and through the first set of double doors. The first six rooms, three on either side of the long hallway hous any number of different logistical things. Water tanks, autoclaves, closets of three-sizes-too-small scrubs (pants falling to hardly past my knee), extra cots and laundry. For the most part these rooms seem unused. And through another set of double doors (2nd set, just like at home minus automation) two rooms with filled cots, a seemingly untended ICU and immediate post-op outpost. The two rooms beyond that are large ORs, deplete of curtains, replete with big French windows and operating tables. Hardly bigger (if at all) than an OR in The States, surgeries are done side-by side, but with plenty of room still to move around and not knock your partner behind you’s scalpel through his patients nerve bundle from a knocked elbow. The large doors entering each room were left open, laminar flow an unnecessary (?) commodity.
Want to know another unnecessary commodity? Spinal blocks following general anesthesia. I watched the anesthesiologist bore a needle into all our patient’s backs until the tip almost dripped out CSF. Then in goes the block. No tears. And only a few patients even winced. Stoicism, now that’s something that we might not think necessary in this setting. But here it is their culture and it is impressive to watch this shine through.
Many of the patients have neglected club-foot. Clubfoot they’ve lived with for five, thirty years, even more. If you don’t know what that means, it’s hard to really imagine. I’ll try to walk you through it. First, pretend walking like a ballerina, right of top of your toes. Now, (and I know most of you can’t even get your foot that straight), take the outside of your foot with the opposite hand and pull it under the ankle, with your toes pointed about forty-five degrees inwards. Next, walk like that until the top of your foot, just outside of your ankle calluses and pads up, just like that thing you used to call your heel. This is your new one. Enjoy. This is no joke.
The procedure for these depends is pretty cool. After releasing the foot by snipping the posterior tibial tendon, the outside half of the foot is opened up and chunks of bone are removed either by hammer or saw, and wrench, until, when pushed back together, it looks anatomically acceptable. Eventually the bone fuses together and though there is much less flexibility in the foot, the patient’s heel will actually be the patient’s heel. Doctor! Doctor! [said in crescendo (that’s volume, not pitch)] Or so I’ve learned from my fanatical father who does this even after giving haircuts. Or he just screams like a little girl (Can someone say if he does this in surgery too please?). I didn’t get that gene. I think this is best followed up with a blood-spattering high-five. Although, that might not be the best idea when your OR has concurrent, parallel beds.
In other exciting news: I’ve heard from CMC people about work this week for next week’s groundbreaking UXO convention in Vientiane. I only hope they still have use for me when I return. Also, one of my friends who I’m sure doesn’t read this got into medical school, so congratulations to her, despite the fact that she neglected to tell me.
Hope all’s well in Vientiane in my absence (or thereby) and back in Seattle. And the rest of the world too. Except for Portland, for a number of reasons. But seriously, straight love.
Also, for some inexplicable reason, I was the only person without a camera today. I guess I forgot that HIPAA doesn't exist in Vietnam. Tomorrow I'll take plenty of personally identifying and gory pictures that I will post with names, ages, hospital, dates, past medical histories, and procedures. (In case this might ever be used against me in the future: NOT ACTUALLY) I have mad (M-A-D) respect for personal privacy and dignity.OK, on more thing. Giants suck.
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