My first operation.

Earlier this week I observed my first operation.
I was a bit trepidatious about the whole matter, but I have resolved
that, if this is something I want to think about long term (working
with MSF), I should become familiar - through proximity - to the sorts
of things that go on in the project every day. Since Liberia is a
pretty stable country, I don't see a lot of gun shot victims or
anything on base. I thought it a good idea to start watching
procedures be done.

In this case, my first procedure was pretty minor. It was, I
understand, a "re-laporotomy". A woman (girl) had had C-section a week
ago, but her abdomen was getting larger and painful. The ultrasound
was not clear if it was infected, blood, or a mass, and the doctors
couldn't really tell be touch, so they decided to 'open her up' again
to find out what the problem was.

As it turns out, it was an infection, and needed extensive drainage.

But for me, it was my first OR procedure!

Some thoughts: not as bad as I thought it would be, very little
stomach turning or gag reflex. The masks you have to wear, combined
with being on your feet, combined with being in Liberia, definitley
made me light headed at times (from overheating and breathing through
the damn thing), but didn't pass out and didn't vomit. All told I
think that I did pretty good for witnessing my first ever live human
being be cut open in front of me. What was striking for me was how the
whole thing works. I mean, on one side of the gown the patient is
awake, with a 'ketamine block'(?), lying there, bored, even getting
chilly and yawning. On the other side, out of view, the surgeon has
her abdomen cut about 10 inches, all the way through, and is just
going at it to get the drainage complete before putting in the
drainage tubes. The whole thing is a little bit surreal, or it was for
me anyway.

To follow up, I went in to the hospital for an assessment on an
emergency case where an individual had managed to get their whole hand
into a cane mill. A motorized cane mill. The hand was thoroughly
crushed, and to make it better the individual had visited a
'traditional healer' who said that he would be able to keep it, but
she took out bone fragments to put back in for better healing later
(!). Severe avulsion (I think that's the word), mushed fingers, the
whole deal. It was a mess.

I contemplated sticking around for the surgery...but in the end
decided I should take it slow. The determination was made to amputate
four fingers. Part of me wishes I had stayed to watch, but I'm really
not sure I could do it yet. How do you know if you can stomach
watching fingers be cut off with a saw? What do I do if I can't? What
does it mean if I can? A whole lot of things I need to think about.
Maybe I'll go next time.

ciao for now-
taj