The next morning we woke up and went to morning prayer. After that we had breakfast and went to rounds. We rounded on 20 patients, men, women, and children, who had everything from congestive heart failure to sickle cell anemia. It was really hot and Kristen almost fainted so she went to lie down. The rest of us finished rounding for wards and split up into groups. Derick and I went with Dr. Clement, a retired orthopedic surgeon to see patients. He says he rarely does surgery here but he sees patients from the casualty (ER) in the morning and afternoon. We saw patients that had lower back pain and he taught us to differentiate between muscle and nerve origins. After the history you do the straight leg raise which is indicative of a herniated disk if positive for pain below 60 degrees. Then you evaluate sensational issues in the toes and feet. For the inside of the foot it is L5, for the outside of the foot it is S1, and for your ankle area sensation is L4. If they are experiencing incontinence it is a medical emergency called saddle anesthesia that needs treatment with first a bladder catheter and then surgery to release the cauda equina compression.
We had tea and then Derick and I went up and found a volleyball court up the hill from the hospital. It was covered in weeds but the net was still up. We went back to clinic, saw a couple more patients, and helped put a cast on one of the patients with a hurt ligament. We took X-rays of his foot and he had no fractures but his ligament was pulled. The surgeon said when we put the cast on that we don't do it circumferentially because the edema might increase and then this would compress then blood supply in the foot. It could also have the opposite effect where the edema decreases and then the cast is loose and doesn't do its job. So for now we did a straight 90 degree angle on the plantar surface of his foot and the dorsal side of his calf. He is to come back in one week and by that time the edema will be stable and we can either put on another plaster Paris cast circumferentially or take off his cast altogether depending on how he is doing.
After lunch I accompanied Derick, Keiko, and Jen to a delivery. We got there just after the baby arrived. The nurse was pulling on the umbilical cord until the placenta came out and she twisted it until it was all out. It was about the size of a mango and very bloody. They had made a right deviated incision dorsally to her vagina to make room for the baby to come through. It needs to be deviated to the side to avoid creating an anal vaginal fistula. Before sewing it up, the nurse injected lidocaine around the vaginal opening. They started deep with a large needle to sew it up. Then they did another layer before doing the superficial layer. Once they got to the skin the patient was very sensitive to the pain so we reinjected lidocaine. The lidocaine was the only anesthetic she got for the entire birth as well. Then we went to visit the baby whose temperature was low and who was under a heat lamp. When we left the family was having a celebration outside labor and delivery. They passed out chocolates to us and we told the family congratulations.
Derick and I went back to afternoon clinic and saw a patient who had been pushed down a hill by his herd of cows. He had a strained lower back but his friend had multiple compound fractures and was sent straight to the larger hospital in Coimbatore. Then we talked for a while with the doctor about all the places he had traveled in the world. After that, Gina, Derick and I went on a walk down the road. The cars definitely like to play chicken with us and see how close to us they can drive before we hop into the bushes. Then we went to five different storefront things to look for a volleyball to play on the court but none of the stores sell balls. They said the next town over did but we didn't want to walk that far. When we came back we finally had running water again in the hospital and we all got to take showers. Then we had dinner, went to evening prayer, and then evening rounds. After that we played spoons, bs, and mafia. We ate twizzlers and trail mix before going to sleep.
No comments:
Post a Comment