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8/17/05 (Wednesday)

Today was another busy and long day.  We started at 6 am making rounds and saw 12 patients.  Once that was done we then started our cases in the OR.  There were 2, hysterectomies, 2 laparotomies for large ovarian cysts, a laparotomy to do a tuboplasty on a lady who has blocked tubes from old infection and desparately wants to conceive, and a little 10 y/o boy with what appeared to be an incarcerated hernia.  He had been living with this very painful mass in his right groin for about 2 weeks before his mother brought him in to be checked.  Jane felt it was a hernia.  Once we got in, however, we found a large necrotic mass that was his testicle that had pulled up into the inguinal canal and then twisted several times around shutting off all blood supply.  Once we got the testicle out, the inguinal canal was okay and there was no hernia.  Poor guy living with this pain for 2 weeks.  Torsion of the testicle is extremely painful and needs action immediately if there is any chance of saving the gland.  The tuboplasty was a difficult decision.  The lady had old pelvic infection with lots of adhesions and both tubes completely blocked and filled with fluid, endometriosis in the pelvis and fibroids in the uterus.  She is in her 20s and wants to conceive.  The pressure in this culture to have babies is tremendous.  If the lady cannot conceive, she becomes a second-class citizen, more or less.  The woman’s worth is being able to produce children.  Getting a sperm count in an infertility workup is not usually successful because the men feel that they could never be the reason for not having children.  It is always the woman’s problem.  Our surgery day was complete at 8:05 pm.  My feet are swollen from standing all day.

One of our patients who underwent a hysterectomy on Monday was up running around and wanting to head home today.  She looked great and only took a couple Vicodin tablets for pain during the 48 hours post op.  She traveled 14 hours by canoe and bus to get to San Lorenzo to get her hysterectomy and she wanted to get on the road to return home today.  At 48 hours she was moving around like she had not even had any surgery.  I’m not sure I would want to make a 14 hour trip on a bumpy old bus and in a canoe when I was only on my second day from major abdominal surgery!  When we told her she could make the trip back up river to her village, she then whipped out a cell phone and made a call.  I found it interesting that she lived in such a primitive village out along the river in the jungle and yet had a cell phone.

Tomorrow, we operate on our cook, Nancy.  She is the wife of the caretaker of the clinic and she does all the cooking for Jane and us.  She has been having a lot of heavy bleeding and fibroids and needs a hysterectomy.  That will be done tomorrow morning, first case.  That means we have to fend for ourselves in the kitchen for the rest of the week.  We have 4 other major cases tomorrow and 5 or 6 on Friday.  We did have a couple cases on Saturday but we plan to move them to Friday so the anesthesiologist can return to Quito Friday evening.  That means Friday may be a very long day and then we will crash on Saturday and Sunday.


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