Monday dawns, enough fresh air and time with friends, and the reality of working in Kenya hits hard. Some badly injured patients have been admitted over the weekend, and, due to a lack of anesthesia, have not yet had surgery. Open fractures edge closer to irreversible infection, a child sits with his displaced wrist fracture untouched, and the list of patients awaiting surgery already today is more than we can get done today.
Decisions have to be made. Cancel his surgery for a broken leg, cancel her surgery for the broken ankle, they aren’t as urgent as what’s before us now.
The first patient is the man with the machete injuries, here for reconstruction. A sour smell emanates from his bandages, and I can feel the dampness as I undo the wraps. Infected! Badly. Too infected to proceed with the reconstructive flap. Wash out the infection, clean bandages, next case.
The lady who’s surgery was cancelled last week due to dangerously high blood pressure is back, her blood pressure is under excellent control. Her wounds don’t look great, but not too bad, so we make a judgement call and proceed with fixing her fractures, using minimal internal metal due to the borderline state of her wounds. Don’t want to encourage infection. The surgery goes well, the orthopaedic resident does most of the case, I just assist, and he does a good job.
Next up, the boy with the displaced wrist fracture. He just needs to be put to sleep, the fracture manipulated back into position, and a small pin put across the fracture. I assist the general surgery resident, and she does a nice job. He can go home tomorrow.
Meanwhile, in Room 8, our visiting surgeon Dr. Thomas Higgins is tackling a brutally hard case. Fractures of the elbow are always very difficult due to the many small fragments, and the difficult three dimensional anatomy. This fracture, however, has been healing in the wrong position for the last six weeks, increasing the degree of difficulty exponentially. He gets the fracture back together in fine form, however, and then runs up to the school to pick up his son from kindergarten.
Another man with a broken arm, and then on to our trauma list. It’s 7 pm, and we have no less than four patients with a combined seven compound (open) fractures waiting for surgery. Going to be a long night.