Sunday, August 26

For awhile this summer I didn't know the date.  I didn't need to.  I went to class in West Virginia, I spent some time in Oregon with my family, and all I needed to know was when to get on an airplane to fly to the next destination.  Now I know the date.  I write the date on the chart of each patient I round on, and the date, and the seven to follow, on the chart of every patient I admit.  I now know the date.  I know one week has passed, and although I've thought about it, I'm actively trying not to count the number remaining.

 

Lisa and I both just finished three calls in a week.  The redeeming part is that it is home call, and home is a short, flat walk - no uphill, no snow, bothways.  But it often times is dark, and/or a torrential downpour/flooding and always vicious killer mosquitoes.

 

I didn't go to local church because I was on call.  (I have not yet ventured beyond the gates of the hospital.)  I can't say I'm necessarily looking forward to local church either.  It is 2.5-3 hours long, its hot, and not in English.  That is a test of will.  The folks on the hospital compound go as an act of solidarity with the local church, and sometimes things are translated into French, although it sounds like that isn't even recognizable to those who understand it.  I was able to make it to part of the compound service, in-between admitting patients to the hospital.

 

My first C-Section was today.  Dr. S was the primary, for which I was thankful.  The procedure was different.  I washed my hands with soap and water, but no scrub brush.  I turned off the faucet with my elbow.  I dried off my hands on a towel so thin it was like gauze, and then double gloved (high rates of infectious diseases - HIV/Hepatitis, etc and poor quality of the gloves combined).  My gown was fabric, and under it I wore a plastic apron.  Under that I wore as scrub top and scrub pants.  Nobody said anything differently, so I just did it.  Supposedly women are supposed to wear skirts, even in the OR.  I feel like I have been very brave with the whole skirt ordeal and if I can take a centimeter (not even a mile), then I will.  I also dawned my scrub cap from Kenya!  (Actually, I have been wearing it daily.  I wore a head scarf for almost three days, and then traded it in for the scrub cap.  Again, nobody has said anything, and I'm not asking.)  After the opportunity to say I'd never been involved in a Nigerien C-section, I was awarded a front row seat to see the action, and we talked through the process that was going to come.  A vertical skin incision on everybody - in part because most are emergencies, and the rest because women don't get C-sections for simple labor.  They get them after 3-4 days of labor, or dead babies, or seizures, etc.  After getting through all the layers down to the uterus, careful to avoid the bladder, there is a low transverse uterine incision, as we typically do in the States. 

 

The indication for this section was a breach baby, and a teenage mom in labor for several days.  There is a characteristic sign of a breach baby after being in labor for several days, and it is not a smooth rounded belly, but kind of like a belly with a belt around it, and rounded at the top and bottom.  I've never looked or noticed it before.  After releasing the heavily meconium stained amniotic fluid, the uterus is not pulled laterally, but from the top and bottom, toward head and feet.  Also different.  Dr. S put his hand in and patiently tried to orient himself to the position of the baby.  The baby's head was down.  Way far down.  IE, not breach.  (My dad was butt-first breech.  Poor Grandma!)  A technician was called in, gloved up, and went under the drapes to push the head back up out of the birth canal where it was well lodged.  The baby was trying to come out face first!  I never saw a face presentation in the States, but it is an indication for C/S!  The baby's head was so misshapen and so elongated.  From chin to back of the head must have measured 10-12 inches.  That kid is going to need a hat for quite some time!

 

The food situation is not nearly as dreadful as I had imagined.  Perhaps it is because we are willing to pay a price.  Between the co-op that has the flour, sugar, butter and canned goods which is open on Tuesday and Friday, the fresh produce/fruit/eggs that are available on Monday, and a local lady takes orders for Samosa's - a flat bread stuffed (I guess I should say filled...no...containing some meat and cabbage), some kind of a fried bread, some kind of a sauce, and fried chicken. 

 

I have made a potato salad (Gram Abu would have been proud, but would have said I used the wrong brand of mayonnaise, the vinegar was too weak and I should have put in onions!), a two bean/corn salad - you know the one with kidney beans, green beans, corn, and a vinegar/sugar sauce, and a cabbage salad - the one with a vinegar/sugar sauce and some ramen noodles in it  (one of Grandma Ma's famous recipes!)  I also ground hamburger with a manual grinder I somehow figured out how to assemble because it looks like one we use to grind fresh clams for chowder at the beach house!  (My grandfather Werner was a butcher, and he would have been proud!)  Today, I made homemade yogurt and naan - an Indian flatbread.  I had to mix yeast with warm water, and wait 10 minutes.  Nothing happened.  Being impatient, I went on and added the sugar and salt to the mix.  Just before adding flour, the phone rang and I had an admission.   The yeast had really gone to town by the time I came back!  I had to let the dough rise twice, and then roll it out.  Next time I'm settling for just plain old bread!  (Although, I may try tortillas again because that was fun to have in Kenya!)

 

At this point, my fridge is full of fun leftovers, so I'll be in good shape for the upcoming week.  But, may need to be careful because the power went out for several hours last night, so I'll have to keep an eye on that.

 

Since I'm on call again tonight, I'm going to try to sleep fast now, before I get called in again!