Wednesday

So, last week was Katie's first Wednesday here at Karanda. Wednesday has traditionally been "Surgery Day" at Karanda, but as of late this has been a bit of a misnomer. Everyday seems to be surgery day since Dr. Stephens is now the only surgeon full-time at the hospital. The other surgeon, Dr. Stephens' father, is currently in the States....he typically did all the ortho cases. So anyway, all of the major elective surgeries are all scheduled on Wednesday and kept on the board until they're done...usually not until Friday or Saturday. Here's a pic of the surgery cases scheduled for Katie's first Wednesday.

So, 19 cases on the board and everything else the day provides, and you never know what the day will provide. On such case was a middle-aged female with lower abdominal pain. She was first seen in the Outpatient Department and was found to have an acute abdomen with vaginal bleeding. I immediately took here to the theatre to do an ultrasound scan. On the scan a tubal ectopic pregnancy was diagnosed. By measurement the baby was about 13 weeks gestational age and was without a heartbeat. The mother's last mentrual period was in June, so this little one had likely expired a few weeks ago, and the mother was complaining of vaginal bleeding and lower abdominal pain for the past month. Basically, this ectopic preganancy had needed to be removed for quite some time. The ultrasound scan also revealed a significant amount of blood in the mother's abdomen, and we soon found out that her hemoglobin was 7 (low). The scan also showed a somewhat unusual finding. There was another small calcification within the cavity of the ectopic. It at first looked like another much younger baby, but I couldn't quite convince myself that is was indeed another baby. Once the scan was done, I poked my head into the theatre to discuss the patient with Dr. Stephens. A middle-aged female with an acute abdomen, vaginal bleeding, and a ruptured ectopic pregnancy.....get her ready for the theatre.

So, Dr. Stephens and Katie open her up to find the ectopic. As Dr. Stephens attempts to free-up the ectopic, it ruptures and there is the small 13 week baby, lifeless. He’s small enough to fit into the palm of your hand, yet he already has all his fingers and all his toes. It never ceases to amaze how we are knit in our mother’s womb and how quickly we take the human form. There’s a moment of silence as we all stare in awe at this little one….saddened that he didn’t make it…encouraged that God alone is in control. Our hearts are heavy, but the case continues. The ruptured tube is removed and the excess blood is evacuated from the abdomen. Since the patient’s hemoglobin is low, the excess blood in the abdomen is collected and then injected into the patient's veins as an autotransfusion. Once everything is cleaned up and tied back together they proceed to close the incision. After the incision is closed, they clean the wound and start taking down the sterile field. While they are doing so, the scrub tech asks Katie if there were twins as she points to another small baby on one of the sterile towels. This one was much smaller than the first and looked to be about 6 weeks old. So, there were indeed two babies in the tube! I’m guessin’ that they were ectopic twins and that one expired before the other. After a quick Google search, I found that this occurs about once out of every 20,000 pregnancies. It's quite a rarity, but then again we're at Karanda. I'm not sure that anything is considered a rarity here. Anyhow, the mom is did quite well and recently went home.

With our staff being a little short-handed, I've been trying to help out by spending some extra time in the Outpatient Department, but I ended up rounding up some more work for the surgery crew. Next an incarcerated inguinal hernia and then an acute bowel obstruction ended up in the theatre. So needless to say, Katie’s first surgery “day” ended up being a surgery “week,” which seems to be more and more the norm around here.

One last parting word;

"O LORD, you have searched me and you know me. You know when I sit and when I rise; you perceive my thoughts from afar. You discern my going out and my lying down; you are familiar with all my ways. Before a word is on my tongue you know it completely, O LORD. You hem me in—behind and before; you have laid your hand upon me. Such knowledge is too wonderful for me, too lofty for me to attain. Where can I go from your Spirit? Where can I flee from your presence? If I go up to the heavens, you are there; if I make my bed in the depths, you are there. If I rise on the wings of the dawn, if I settle on the far side of the sea, even there your hand will guide me, your right hand will hold me fast. If I say, "Surely the darkness will hide me and the light become night around me," even the darkness will not be dark to you; the night will shine like the day, for darkness is as light to you. For you created my inmost being; you knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well. My frame was not hidden from you when I was made in the secret place. When I was woven together in the depths of the earth, your eyes saw my unformed body. All the days ordained for me were written in your book before one of them came to be. How precious to me are your thoughts, O God! How vast is the sum of them! Were I to count them, they would outnumber the grains of sand. When I awake, I am still with you."

In HIM>

kevin.