Jun 12, 2011
It’s another busy week. But the tiredness was driven by the excitement of last two days. Early this week, we had admitted a young man whom was hit by a car on left chest wall. Chest X-ray showed blood in left chest and collapsed left lung but no rib fracture. The Emergency Room doctor had put in a chest drain which drained more than a liter of blood. The lung was re-expanded. But, when we removed the chest drain, we found the left diaphragm seemed high and the stomach shadow was in left chest. I repeated another film which showed stomach and bowel gases in left chest. Clinically he was very good. There was no pain in chest or abdomen, or any breathing difficulty. In fact, we would like to discharge him. I strongly suspected he had rupture of diaphragm ( the muscle separates the chest and abdomen and helps our breathing ) with stomach and bowel getting into the chest. But he was too well for me to go ahead for surgery. I ordered a special contrast study (Barium meal and follow through ), which the patient had to be sent to outside private radiology laboratory for study and MSF had to pay.. The report confirmed my suspicion. I operated on him yesterday. There was a 15cm radial tear on the left hemi-diaphragm. The stomach, small bowel and the spleen were all inside the left chest cavity. Luckily, there was no injury to all organs. I had to pull everything back to abdomen and repaired the tear. All the OT staffs were excited. This man is a saxophone player. He asked me whether he could play saxophone again. I promised him it would be the same. I received another emergency call at 1am this morning. A man was hit by falling object at lower abdomen. He had pain and passed blood in urine. Otherwise, he was stable. I suspected he had fracture of pelvis and rupture of urethra (passage of urine ). I asked the ER doctor to take X-ray of him and not to insert any catheter for him. If he could pass urine, his urethra would be alright. We might turn a incomplete tear of urethra to a complete one if we are not familiar with the catheterization. I saw him in the morning. As expected, he could not pass urine and had a full bladder. X-ray did show fracture of the pubic bones. I attempted to insert an urine catheter for him in the theatre but failed. I decided to go in and found there was complete rupture of the urethra. I did a rail road technique and successfully reconnected the two ends of urethra. All were very excited. Camille, the French orthopaedic surgeon even took a video while I was operating. In fact, in the morning I assisted Camille to operate on the six years old girl whom I had mentioned to you before. She had a fracture dislocation of right elbow around a year ago with a stiff elbow. We finally chose a day and performed an open reduction for her today. It was very successful. Her right elbow could regain almost ninety percent of the range of movement. Both of us are very happy with her. It’s always cheerful to share these stories rather than blood shed. And it’s also the reason makes me coming to mission again.