Trouble with the man with the snakebite

Yesterday was a busy day. I was called back to the hospital at 7:30am and worked until 8pm, almost non-stop. I slept at 9:30pm after my supper and a bath, and woke up again at 5:30am. Fortunately, I had not been called. Or I might well be in a coma and they could not have woken me up. It was the sweetest sleep I have ever had in Monrovia. I had performed two laparotomies, one closure of an ileostomy, repair of two large irreducible hernias, one faciotomy for a man with snakebite and one chest empyema drainage in the day. Together with John's exploration, we had two cases of small bowel perforation duo to typhoid fever. Typhoid is common in Liberia probably due to the poor hygiene and contaminated water source. We need to have a vaccination against typhoid before coming here. The water truck supplies all the water we use and we have to filter or boil the water before we drink. In the evening, there was another 25 year old young man coming in with a very similar story of typhoid perforation, constipation for a week, followed by 4 days of abdominal pain, bloody diarrhoea and fever. He did not look as toxic as the other two. But to my surprise, it turned out to be a case of ruptured carcinoma of the liver, which we often encounter in Hong Kong. The bleeding apparently stopped by itself. I ligated the hepatic artery. I explained everything to his wife and brother after surgery. They were ignorant of this disease but very disappointed to know that it is unresectable and his life expectancy is short. We had some trouble with the man admitted with snakebite earlier. It is very difficult to control bleeding from the muscle after a fasciotomy, which is a procedure to slit open the fascia covering the muscle and to release the pressure underneath, as the muscle would die and swell up after a snakebite. The high pressure may jeopardize the blood supply to the hand and it may die. After controlling the patent's bleeding, he then developed a very rapid heart rate, possibly partly due to bleeding and partly due to the release of the toxin after the fasciotomy. Fortunately, it went well. I met his mother and sister every time I went out of the operating theatre since they were waiting outside. I explained to them the patent's condition. They were very concerned about his life and the function of his hand. They were very thankful. A chest drainage was performed on a five year old boy referred from Island Clinic in Monrovia. He is suffering from tuberculosis. It seems only skin and bone are left on his body. He had developed a collection of pus in his left chest requiring drainage. Island Clinic in Monrovia is a designated clinic looking after children with tuberculosis. As the children may have lots of side effects from the toxic anti-TB treatment, there are paediatricians giving advise on treatment. The night before, we had our Hospital Field Coordinator back from her training in Barcelona. She is an English nurse. Together with the Medical Coordinator (a beautiful Italian girl), a French Medical Doctor, a Nigerian Medical Nurse and our French OT Nurse I/C, the women rule the hospital. Of course, four of us, the male anaesthetists and surgeons have to listen to them in order to have an easy life here. Au Yiu Kai