The Theater

Tuesday marked my first day in the theater. I began my morning by going through ward rounds with the surgeons. I was shocked to see a 15 year old boy who had survived a stab wound through the heart. Stab wounds are extremely common. The surgeons and trauma team here at GF Jooste have an unbeleivable survival rate. They are experts at saving those afflicted by stab wounds. I also saw an older man who initially had a mildly infected hair follicle which spread laterally until the infection covered his entire occipital region over 2 weeks. The solution to a carbuncle like the one this man developed is debridement of the area until the tissue bleeds and healthy tissue remains. The patient lost a tremendous chunk of tissue from the back of his head. The dressings are changed and the skin heals from the bottom up. I also saw a man who was in a car accident and suffered a superficial anterior tibia wound. It became infected and the area had to be removed. He was in for a skin graft to cover the area. He has been healing nicely over the last few days. These are just a few of the cases I saw on ward rounds. In surgery I saw a woman with a left ovarian ruptured abcess brought on by pelvic inflammatory disease that had been present for far too long.
A common theme among the cases they see here is that most patients wait very long to be seen. Their conditions have progressed much further then they should and the solution is surgery. For example, on Wednesday a diabetic man presented with a wet, gangrenous foot. He was going in for a below knee amputation. He has peripheral vascular disease and he had already lost his left foot. In patients with uncontrolled diabetes amputation is often inevitable. In surgery I got to watch a spinal block. Sometimes spinal blocks can be tricky if the ligamentum flavum (the ligament connecting the spinous processes) is calcified. This man had calcification which required some force to drive the needle into the subarachnoid space. The result after anesthetic is administered into the area is that the patient cannot feel anything below the waist. I saw another spinal block done on a young girl about my age who had a complete distal fibular fracture. It was quite a cool surgery to watch. I could see the bone and watched the orthopedic surgeon place a plate along the bone and screw it in place. Wednesday was a good surgery day!
Today I went on ward rounds. An older man was struggling with the decision on whether to agree to a below knee amputation. He fears the stigma of being crippled and chose to wait and discuss the matter with his family. His right foot was gangrenous and would either continue to rot upwards or require amputation down the road. He too had peripheral vascular disease. It's hard to see patients put off making decisions that would greatly improve their health, but in the end it is their choice to make. In surgery I watched a colostomy creation. This a re-routing of the colon so that a hole is made in the abdominal wall and the colon is attached to the opening. A bag is then attached and the individual will pass fecal matter through the opening. This lady had a malignant obstruction which prevented normal bowel movement. Surgery has been exciting and I have had the opportunity to see anatomy in action!