Shanksteps #100
By Greg Shank
July 7, 2008
I had gotten a slow start on the day. I had dealt with administrative issues for an hour, then saw about 8 outpatients in clinic. Next was the surgery, a hysterectomy for cancer. Just as I was heading over there they called me to see a maternity patient. She was pushing and the baby was dropping his heart rate extraordinarily with every contraction. So she became the first patient for an operation. We did an urgent Caesarean section to take out the baby that was having problems with the vaginal birth process. The baby cried and I was happy. After having some that have to be resuscitated or dead at C- section, a crying baby is always a joy to the doctor also. As I was writing my postoperative note, they said there was a patient outside with a strangulated hernia in his groin. So I went and examined him. What I felt was crepitance (feeling of bubbles under the skin) all over his right lower abdomen with a mass in his right groin that was very edematous.
This was a sign of “gas gangrene”, a rapidly expanding infection that needs immediate extensive debreedement for removal of all infected tissue. So we “quickly” (one hour) changed the room over to be ready for the new patient. He was 50 and had about 20 villagers with him outside. As you have to in these infections, I debreeded all the infected tissue, leaving his muscles exposed from his chest down to his groins on both sides. I also explored the right groin and found an strangulated, ruptured femoral hernia that smelled worse than rotten eggs. I also explored his abdomen and found the gangrenous section that had burst, bringing that out as an ostomy through a small patch of skin left in his left upper abdomen.
Through prayer and Gods healing he has made it out 5 days so far and it appears that the infection is controlled. Praise HIM! Now that we were done with him, we did the remaining hystoretomy. We chose to take an hour or two break to eat, then start the next one at 7PM. As we entered her abdomen we found a small uterus with a large cervix that was cancerous. It seemed like it could be removed and there was no evidence of spread. I started removal and found it strongly adhered to the bladder. The family had voiced their interest in doing anything that would help her have a longer life, so I proceeded to resect the cancer. It was very tedious and long.
After about 5 hours I had finally taken out the uterus along with ureters on either side, which were included in the tumor. I then had to create a conduit for the urine to the abdominal wall as an ostomy. This took another couple hours of hand sewing, oh how I wish for staplers like in my training. Finally I sewed up the skin and was done, 3AM. It was one of the most extensive surgeries I’ve done here. Her conduit is working now, she is drinking bouille (local porridge) and I praise God again for his healing. It is SO UNLIKELY that either one of these would be doing well, or alive after all that has happened to them. Please keep them in your prayers as their recoveries will be very slow. Also pray for our travels and our safety.
We are leaving for the US June 21 at midnight and will return to Cameroon at the end of August. We will be leaving through N’djamena, Chad and there is rebel activity that want to overthrow the Chadian government. Please pray for us and for James and Sarah Appell and Gary and Wendy Roberts, both missionaries in Chad.